As of December 7, retirees and other beneficiaries can change their Medicare coverage during open enrollment. During this time, you can choose between Original Medicare (Parts A and B), a government-provided benefit, and Medicare Advantage plans (Medicare Part C plans), which provide the same benefits but through private insurers, as well as additional coverage for dental care, vision care, and prescription drugs, depending on the plan.
With inflation putting a strain on many people’s wallets, an alternative Medicare plan might help reduce costs. Changing plans may also be necessary if your location or medical requirements change.
Given some of the economic difficulties we’re experiencing this year, it is wise to review your options, says Bob Rees, vice president of Medicare sales at health insurance marketplace eHealth.
Open Enrollment: Why You Might Need to Change Your Medicare Plan
While every Medicare recipient has the option to switch plans during the open enrollment period, it appears that few take the time to do so. In 2019, fewer than one-third of Medicare enrollees compared plans, according to a Kaiser Family Foundation analysis from 2021.
Skipping this stage, on the other hand, might be a mistake, especially if any of the following are true.
Medicare Advantage plans are often limited to a specified geographical area. If you relocate, you may have difficulty finding providers that accept your plan, and utilizing out-of-network doctors may result in considerably higher co-insurance expenses.
“The strategies differ, frequently at the county level,” Rees notes.
If you anticipate moving out of your plan’s coverage region but will not do so until later in the year, you may wish to maintain your existing insurance for the time being. There is a unique enrollment time when you leave your plan’s service zones that permits you to transfer plans.
The Network of Your Plan Is Changing
Medicare Advantage plans are frequently run as health maintenance organizations (HMOs) or preferred provider organizations (PPOs) with a network of participating physicians. However, networks do not always remain the same year after year.
Check that your favorite physicians and healthcare facilities are still in-network before renewing your existing Part C coverage. Prescription medicine formularies (the list of drugs covered by your plan) are also subject to change. If your plan’s formulary has changed and your medication is no longer covered, you may wish to switch plans during Medicare open enrollment in 2022.
You’ve been diagnosed with a new disease.
If you get a new diagnosis, such as diabetes or cancer, speak with your doctor about your treatment options for the coming year. Then, ensure your existing Medicare Advantage plan covers anticipated specialists or prescriptions.
Your out-of-pocket expenses are rising.
When a plan’s premiums or out-of-pocket payments alter, it’s an indication that it’s time to obtain new coverage. Other Medicare Advantage plans may have cheaper rates, and others may not have any at all.
According to Rees, people frequently go toward premium-free plans as their initial choice. Check the co-payment criteria before signing up for a plan because it doesn’t charge a monthly price. It’s sometimes wiser to spend a higher premium for a plan that covers more of your expenses.
You Want More Advantages
According to a poll on behalf of The Commonwealth Fund, a charity dedicated to improving healthcare systems, over half of Medicare enrollees (45%) will participate in Medicare Advantage plans in 2022. According to the report, about a quarter of individuals with Medicare Advantage chose such a plan because it provided additional advantages.
Many Medicare Advantage plans include services not available under Original Medicare, such as vision and dental coverage. According to Rees, they may also provide supplementary benefits like gym memberships or transportation coverage.
Even if you’re satisfied with your current Medicare Advantage plan, it may be useful to examine your alternatives to see if you may get more or better benefits elsewhere.
Medicare recipients can purchase Medicare Supplement insurance, generally known as Medigap policies. They can also provide advantages that Part C does not, like as emergency medical care when traveling abroad or supplemental coverage for skilled nursing facilities.
Only people with Original Medicare can buy Medigap coverage. So, if you have a Medicare Advantage plan, you need to switch back to the original Medicare to buy Medigap coverage.
Buy Medigap coverage after your original enrollment period ends at age 65. It is possible that you will be subjected to medical underwriting, which means the insurance company supplying the plan may raise your rates depending on your health condition, costing you more. As a result, a Medigap plan may not be available or accessible to everyone since they either reject coverage due to a health condition or offer a cost that is too high.
Original Medicare Is Your Preference
While Medicare Advantage plans include additional services and supplementary benefits, Original Medicare has one key advantage: it may be utilized anywhere.
Original Medicare doesn’t care whether your preferred provider or hospital is in a network. According to a Commonwealth Fund poll, 40% of individuals who choose Original Medicare do so because they want additional doctor, hospital, and health care provider options.
Diabetes patients may also wish to select Original Medicare, given a 2023 change that restricts the monthly cost of insulin to $35. If you decide to convert to Original Medicare, remember that prescription drugs, including insulin, will need to be covered by a separate Part D plan.
The Advantages and Disadvantages of Switching Medicare Benefits in 2023
Consider the pros and downsides of switching coverage as you plan your Medicare benefits for 2023.
- Reduced premiums and out-of-pocket expenses
- Extra advantages and services
- Possibility of seeing new network providers
- Inability to use earlier providers that have since gone out of business
- If you switch to Original Medicare, you must purchase a separate Part D coverage.
- You may need to learn how to use the new insurer’s website and the new claims process.
Switching Medicare Advantage (Part C) Plans
If you’re ready to switch plans—or at least evaluate your options—there are three basic actions you can take.
Begin by visiting Medicare.gov. The Centers for Medicare & Medicaid Services has a searchable database that allows beneficiaries to find and compare plans in their region. You may also enter your prescription prescriptions into the search to see which plans cover them.
Speak with a Licensed Insurance Broker.
You may also compare your plan alternatives with a registered insurance broker. Make sure the broker offers a diverse range of options rather than just one or two, Rees says.
Some services, such as eHealth, allow customers to look for plans independently and then connect with a licensed broker if they have any issues. According to Rees, elderly people should be aware of fraudsters who may try to take advantage of them. Request a license number from anybody and be aware of anyone who demands a price for their services.
According to Rees, working via a licensed broker costs nothing extra.
Enroll in Your New Insurance Plan
Once you’ve decided on a plan, just enroll with the new provider to complete the transition. According to Rees, outdated plans are instantly terminated because all application data is received through CMS.
Your updated policy will become effective on January 1, 2023. From January 1 to March 31, there is a special open enrollment period for Medicare Advantage plans if you decide to change your mind. During this time, you can switch to another Medicare Advantage plan or Original Medicare.