Are you currently enrolled under a Medicare Advantage (MA) plan but want to change your coverage? The good news is that for Medicare Advantage enrollees you have a special period you can request changes annually during the Medicare Advantage Open Enrollment Period.
This article will cover what you need to know about this special enrollment window before changing your Medicare Advantage plan.
What is the Medicare Advantage Open Enrollment Period?
This is an optional enrollment period wherein Medicare beneficiaries enrolled in Medicare Advantage can switch coverage. The Medicare Advantage Open Enrollment Period was first announced by the Centers for Medicare and Medicaid Services (CMS) in 2019 and is currently still available for Medicare Advantage beneficiaries.
During the MA-OEP, which is the three-month period between January 1 to March 31, you have the opportunity to do the following:
- Switch from your current Medicare Advantage plan (with or without drug coverage) to a different Medicare Advantage plan (with or without drug coverage)
- Switch from your existing Medicare Advantage plan to Original Medicare and purchase a standalone Part D Prescription Drug Plan (PDP) (if required).
Who is eligible?
Only those enrolled in the Medicare Advantage plan as of January 1 are eligible to apply during the Medicare Advantage Open Enrollment Period. This can mean anyone who falls under these categories:
- You renewed your existing Medicare Advantage (MA) plan, which means you did not opt to change plans during the Annual Election Period (AEP) between October 15 and December 7 and now want to switch. Read this article to find out more about AEP.
- You switched from one Medicare Advantage plan to another Medicare Advantage plan during the AEP enrollment period but are unhappy with your plan and want to switch plans.
- You were a first-time enrollee and recently enrolled in a Medicare Advantage plan during your Initial Enrollment Period but would like to consider a different plan.
If you are on Original Medicare (including if you have a Medicare Supplement or standalone Prescription Drug Plan (PDP) you are not eligible to do anything during the MA-OEP and are not allowed to enroll in a Medicare Advantage plan.
What am I specifically allowed to do during the Medicare Advantage Open Enrollment Period?
During the Medicare Advantage Open Enrollment Period, you can request one of these 4 changes:
- Switch to another Medical Advantage plan (also known as Medicare Part C) with bundled drug coverage, also called an MA-PD plan
- Switch to another Medical Advantage plan that does not have drug coverage
- Switch to Original Medicare with a standalone Part D Prescription Drug Plan
- Switch to Original Medicare without a standalone Part D Prescription Drug Plan
Note that if you have a Medicare Advantage plan with a standalone Part D plan, you can switch to another Medicare Advantage plan that does not include drug coverage. However, you cannot change your standalone Part D Prescription Drug Plan.
You can only request once during the Medicare Advantage Open Enrollment Period.
Your new coverage will take effect on the first day of the month after your new plan gets your request. For example, if you send your request anytime in January, your coverage will change effective February 1.
How is it different from the Annual Election Period?
Another enrollment period that most Medicare beneficiaries will be familiar with is called the Annual Election Period (AEP) or the ‘Medicare Open Enrollment Period’. Although both periods involve the ability to change in coverage, there are key differences:
- The Medicare Advantage Open Enrollment Period (MA-OEP) period occurs between January 1 to March 31, whereas the AEP is from October 15 to December 7 every year.
- MA-OEP is only available to those enrolled in a Medicare Advantage plan as of January 1, while AEP is open to all Medicare beneficiaries.
- MA-OEP only allows one change during the three-month period. In AEP, however, you can request multiple changes during the AEP period. Your last choice is the one that goes into effect on January 1.
Should I do anything during the Medicare Advantage Open Enrollment Period?
The Medicare Advantage Open Enrollment Period is an important window that allows you to review your coverage. If you are happy with your current plan, you can continue with it. However, if your circumstances changed, you didn’t switch plans during AEP but found your costs increased, you changed to a new plan during AEP but are not happy with it, or you see other Medicare Advantage plans with additional benefits that are important to you, you may want to re-assess whether a change is necessary.
Some important questions you should research and ask yourself include:
- Are your current doctors still under your current plan?
Doctor networks can change often and your current doctors may no longer be in-network for your current plan or may have joined other insurance providers.
- Have you noticed an increase in your out-of-pocket expenses but didn’t change plans?
Check your plan’s deductibles and copayment/coinsurance and compare this against the structure of other Medicare Advantage plans.
- Did your health improve or worsen over the last year?
Assess if you need more (or less) coverage, especially regarding medications. Prescription drugs are often the biggest cost for some beneficiaries and plan formularies (the list of drugs each plan covers) can change year-to-year, increasing your costs if your drugs are no longer covered
- Are you satisfied with the services of your current Medicare Advantage plan?
All plans receive a quality star rating out of 5 stars from the CMS. If you are unhappy with the quality of care you are receiving, find a plan with a better rating.
- Are you interested in Medicare Advantage plans offering more extra benefits like a gym membership, dental or vision coverage?
Plan benefits are getting better each year and you may find a new plan with better benefits that match your health goals.
According to an article by the Kaiser Family Foundation (KFF), there are up to 3,550 Medicare Advantage plans across the nation to choose from in 2021. Therefore, you will most likely find one plan that matches your needs.
Based on the facts given, seriously consider whether a change in coverage is necessary, especially if you foresee a change in your medical and financial needs. Take advantage of the Medicare Advantage Open Enrollment Period to initiate changes.
At CoverRight, we’re here to help you find the right coverage that you deserve. Reach out today and start finding the best Medicare plan for you.