How And When To Change Medicare Plans

To get better coverage and save money, you may want to change Medicare plans during the Medicare Open Enrollment period from Oct. 15 to Dec. 7. You can switch from one Medicare Advantage plan to traditional Medicare or another Medicare Advantage plan (or from traditional Medicare to a Medicare Advantage plan). And, you can switch from one Part D prescription drug plan to another.

• Traditional Medicare:
  • Traditional Medicare is the health coverage you get directly from the federal government. It is the choice of the vast majority of people with Medicare because it covers care from most doctors and hospitals throughout the country.
  • You pay a deductible -- your out-of-pocket cost before your coverage begins -- and coinsurance for most of your care; but, you can fill gaps in coverage with supplemental insurance.
  • Supplemental insurance -- Medicaid, retiree coverage from a job or a Medicare supplemental insurance plan you can buy -- fills all or most Medicare coverage gaps. You need this insurance to protect you from paying a lot out of pocket if you need costly care. It also allows you to budget for your health care.
• Medicare Advantage plans:
  • Commercial health plans that contract with Medicare.
  • Medicare Advantage plans usually only cover your care from a restricted group of doctors and hospitals in your community, except in emergencies or urgent care situations. And, you can't always count on seeing the same network doctors. The provider network is always changing, with doctors and hospitals joining and leaving the network.
  • You may pay an additional premium (on top of the Part B premium), a deductible (the amount you pay before coverage begins) and a copay or coinsurance, every time you get care. Each year, these costs can change. There is no coverage you can buy that will fill these gaps.
  • You may spend less than you would with traditional Medicare so long as you see network doctors and do not need costly care.
  • If you end up seriously injured or diagnosed with a complex condition, you may end up spending a lot of money. Your out-of-pocket costs could be as high as $6,850 limit for in-network care and much more if you want to use doctors and hospitals not in the network.

• Look at the plan's Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) to see new premiums, deductibles and copays. If you're OK with them, make sure your doctors and hospital are still in the network.
• Check out your other health plan options, including traditional Medicare. You may find that another option better meets your needs. If you need help figuring out what to do, you can call your State Health Insurance Program or SHIP . You can also call 1-800-633-4227 (1-800-Medicare). And, you can use this Medicare tool to understand your options.
• You should not switch to another Medicare Advantage plan until you have called the plan to make sure you fully understand your costs and which doctors and hospitals are in the network.
• To switch to traditional Medicare or another Medicare Advantage plan, call 1-800-633-4227 (1-800-Medicare) to let Medicare know.
• After switching to a Medicare Advantage plan, if you don't like it, you can dis-enroll any time between Jan. 1 and Feb. 14 and enroll in traditional Medicare (but you will want to get Medicare supplemental insurance as well.)

• Look at the drug plan's Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) to see new premiums, deductibles and copays or coinsurance. If you're OK with them, check to see what you'll pay for the drugs you're taking.
• Look at other drug plan options. There could be a plan that covers your drugs for less money. Medicare offers a tool for comparing drug plans.

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