By Hal Sadowy, vice president and general manager
for Today’s Health® HMO in Wisconsin
If you are on Medicare and believe your current Medicare Advantage plan is not meeting your health care needs, you may be eligible to change your plan under the current Open Enrollment Period that ends March 31. After this deadline passes, you may be “locked in” to your current plan until the next enrollment period in November.
Medicare’s “Open Enrollment Period” (OEP) extends from January 1 to March 31 each year. People with Medicare enrolled in Original Medicare or a Medicare Advantage Plan can switch plans one time during this three month period, if they believe the plan they originally enrolled in is not the best fit. After March 31, participants will be locked into their current plan until the November Annual Election Period unless special enrollment eligibility requirements are met.
The rules for switching plans during OEP are as follows:
- During the Open Enrollment Period, you have one opportunity to enroll in, disenroll from or change a Medicare Advantage plan to a “like” plan.
- If you have a Medicare Advantage plan without prescription drug coverage, you may not add Medicare Part D prescription drug coverage during this time
- If you have Original Medicare and a Medicare Part D Prescription Drug Plan, you have one opportunity to drop your stand-alone Prescription Drug Plan and enroll in a Medicare Advantage plan with Prescription Drug Coverage (MA-PD plan).
- Changes made during Open Enrollment become effective the month after the change is made.
When evaluating whether to switch Medicare Advantage Plans, Today’s Health HMO recommends taking a three step approach: evaluate, discuss and decide.
*In certain situations, people with Medicare may be eligible for a Special Enrollment Period.
Evaluate
First, consider how much you paid in the past year for medical services – doctor visits, hospital stays, prescriptions and other related charges. Remember to look at the overall cost, not just outof- pocket expenses.
Next, when evaluating other plan options, consider the following questions:
- How much am I willing to pay out-of-pocket for monthly plan premiums, deductibles and co-pays?
- Do the other plans offer the same level of benefits or more?
- Are wellness benefits offered as part of the plan?
- What coverage do I need for special medical conditions or treatments?
- Does the plans network of providers serve my area, or will I have to travel for doctor visits?
- Is my doctor in the network, or is there a large network of doctors from which to choose?
Discuss
Consider asking for advice from someone you trust. For example, your doctor or pharmacist can often provide you with a wealth of helpful information to aid in your decision. Your doctor may only accept certain plans so it is vital that you confirm before you switch your current plan.
Family members and friends who have original Medicare or a Medicare Advantage Plan can also be an excellent source of information. Ask them about their personal experiences with their plan providers. Does the quality of service meet their expectations? Are they happy with the plans deductibles, co-pays and monthly premiums? What, if any, difficulties have they encountered? Would they recommend their Medicare Advantage Plan?
Decide
Once you feel comfortable making a decision, there are several possible steps to take.
- If you decide to stay with your current plan there is no action required.
- If you’re enrolled in Original Medicare and want to join a Medicare Advantage Plan, contact the Medicare Advantage Plan you wish to join. They will walk you through the process.
To change from one Medicare Advantage Plan to another, contact the plan you wish to join. Your membership will be automatically discontinued from the previous plan.
For more detailed information about enrolling in a Medicare Advantage plan, including instructions on how to enroll, visit www.medicare.gov. You can also call 1-800- MEDICARE (1-800-633-4227). TTY users call 1-877-486- 2048. Representatives are available 24 hours a day seven days a week.
Whatever you decide, weigh your options carefully. You can only change plans once during the OEP.
