It's Medicare Open Enrollment season. Here's what to consider if you want to change plans

Medicare Advantage Open Enrollment season runs Jan. 1 through March 31, and it’s the window when people with Medicare Advantage plans—sometimes called Medicare Part C—can switch to a different plan or to traditional Medicare. 

Medicare Advantage plans often offer coverage traditional Medicare doesn’t, sometimes with low or zero premiums. But unlike traditional Medicare, the Medicare Advantage plans limit beneficiaries to certain doctors and hospitals (known as provider networks) and generally require prior authorization before you can see a specialist or have a medical treatment.

Medicare Advantage and traditional Medicare beneficiaries have similar rates of satisfaction with their care and care coordination overall. 

Once you decide on a new Medicare Advantage plan or to move to traditional Medicare, that election takes effect the first of the next calendar month.

“It warrants doing a cost-benefit analysis,” advises David Lipschutz, associate director for the Center for Medicare Advocacy in Washington, D.C. “I think it pays to do one’s homework and to really weigh all the pluses and minuses.”

Choices, choices, choices

If you’re thinking of switching Medicare Advantage plans, you’ll have plenty of choices. 

There are nearly 4,000 Medicare Advantage plans offered nationwide; the typical beneficiary has 43 options where they live, according to the Kaiser Family Foundation.

“They make it as easy as possible to switch Medicare Advantage plans. It’s pretty much a click or two,” says Philip Moeller, the Richmond, Va.–based author of Get What’s Yours for Medicare and the “Get What’s Yours” newsletter on Substack.

If you’d like a different Medicare Advantage plan because you’ve been unhappy with yours, look for one with the doctors and hospitals you prefer. Medicare’s free Plan Finder tool can help you get started. You can also call your physicians to see which Medicare Advantage plans they and their affiliated hospitals are in, says Moeller.

You should also call the Medicare Advantage plan you’re considering and ask a rep to explain its prior authorization rules, so you can understand how onerous they are. The Kaiser Family Foundation recently found that roughly 6% of requests for Medicare Advantage prior authorization were rejected.

Find out, too, whether the prescription drugs you take, and their dosage, are covered in the particular Medicare Advantage plan you’re considering, as well as how much they would cost. Keep a list of your prescriptions in your My Medicare account profile on Medicare’s site for easier comparison.

Next, compare the benefits of a new Medicare Advantage plan with the plan you’ve been on. 

“Extra benefits are often touted as an advantage of Medicare Advantage plans, but in reality, they often are quite limited and do not necessarily live up to the promise,” cautions Lipschutz. “Avoid being swayed by the bells and whistles. Often, considerations made because of such bells and whistles are at the expense of things like restricted provider networks, onerous prior authorization requirements, and other barriers to care.”

Switching from Medicare Advantage to traditional Medicare

Maybe you’ve decided you’d rather have traditional Medicare than a Medicare Advantage Plan. That means you’ll need to sign up for Medicare Part A (hospital and home healthcare coverage), Part B (doctor’s bills, outpatient care, and medical equipment coverage), Part D (prescription drug coverage), and probably a Medicare supplement or Medigap policy.

The Medicare site’s Plan Finder will let you compare Part D and Medigap plans.

“Look for a Part D plan that covers all your drugs and will estimate your annual expenses,” says Moeller. “I would use that rather than a great premium offer, which may obscure some add-on costs that aren’t as favorable. If you have very minimal drug needs, though, I would get the cheapest premium plan possible.”

Bear in mind, however, that you may need to be approved to qualify for a Medigap policy unless you live in Connecticut, Maine, Massachusetts, or New York, where coverage is guaranteed regardless of your medical history.

Getting help with your decision

You may want to consult an expert when deciding whether to switch Medicare Advantage plans or sign up for traditional Medicare. 

Private Medicare brokers can help you find Medicare Advantage, Medigap, and Medicare Part D plans. Just remember that they represent multiple insurance companies, but not all of them, and they’re paid by the insurers.

Lipschutz recommends calling your State Health Insurance Assistance Program (SHIP) to speak with unbiased, one-on-one Medicare counselors. “They won’t tell you what to do, but they’ll give you information so you can make an informed decision about what’s best for you,” he notes.

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