How to Change Plans

How to Change Plans

It’s wise to review your plan every year and evaluate whether it’s right for you based upon coverage, convenience, and cost.

Open Enrollment is the time each year when you can review your coverage and make changes to your plans. During Open Enrollment you can:

• Change from Medicare Parts A and B (Original Medicare) to a Part C (Medicare Advantage) plan
• Change from Medicare Advantage back to Original Medicare
• Join, drop, or switch to a Part D prescription drug plan
• Switch Medicare Advantage plans

Make sure you review your options carefully so you can choose the plan that best suits you.

Special Enrollment Periods

In some cases, you can enroll or switch plans outside of your Initial Enrollment Period and the annual Open Enrollment Period.

These Special Enrollment Periods (SEP) include changes to your life situation; such as:

• You lose the insurance coverage provided by an employer, union, or Medicaid
• You become eligible for Extra Help
• You move out of your healthcare plan’s service area
• You have an opportunity to get other coverage

See a full list of special circumstances at Medicare.gov or contact your local Social Security office and ask if you qualify for a Special Enrollment Period.

Declining Part B Coverage

If you have medical insurance through your job or an actively working spouse, you may want to keep Part A (hospital insurance) and delay enrolling in Part B (medical insurance) until later. There are two ways to drop Part B if your Medicare coverage hasn’t started yet:

• If you were automatically enrolled in both Part A and Part B and sent a Medicare card, follow the instructions that come with the card and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.
• If you signed up for Medicare through Social Security, contact your local Social Security office.

If you delay enrolling in Part B when you are first eligible, you may be subject to a penalty you’ll have to pay in addition to your Part B premium unless you qualify for a Special Enrollment Period (SEP). Check with your local Social Security office and ask if you can decline Part B coverage without penalty.

Adding Medicare Advantage to Original Medicare

If you want to enroll in a Medicare Advantage (Part C) plan, you can only do so during specific times:

• If you are new to Medicare, you need to enroll during your Initial Enrollment Period (IEP). This is the 7-month period when you first become eligible for Medicare: three months leading up to your 65^th birthday, the month of your birthday, and the following three months. After you enroll in Part A and Part B, you can choose to enroll in a Medicare Advantage plan.
• If you have already enrolled in Medicare Part A and Part B, you will enroll during Open Enrollment Period (OEP) which falls between October 15 and December 7 of every year. During this time, you can switch from Original Medicare to a Medicare Advantage plan or vice versa.

If you have Original Medicare with a Medigap policy and you switch to Medicare Advantage, you most likely will not be able to get the same Medigap policy again if you decide to switch back.

The date your coverage begins depends upon the period in which you enroll. It would be wise to keep any existing coverage until your Medicare Advantage plan has started.

Switching Medicare Advantage Plans

If you want to switch from one Medicare Advantage plan to another, the Open Enrollment Period (October 15 – December 7) is the best time to do so.

Once you select a new plan and enroll, you’ll automatically be disenrolled from your old plan when your new plan’s coverage begins. You do not have to contact your old pan to disenroll.

Changing from Medicare Advantage to Original Medicare

You can leave your Medicare Advantage plan to return to Original Medicare during two time periods each year:

• Open Enrollment Period (October 15 – December 7)
• Medicare Advantage Disenrollment Period (January 1 – February 14)

If you disenroll from Medicare Advantage during the Medicare Advantage Disenrollment Period, you will have until February 14 to enroll in a stand-alone Part D plan for prescription drug coverage. During this time, you cannot move from Original Medicare to Medicare Advantage or switch Medicare Advantage plans; you may only move from Medicare Advantage back to Original Medicare. If you want to switch Medicare Advantage plans, you may do so during Open Enrollment.

If you re-enroll in Original Medicare during this time, your coverage will start on the first day of the following month in which you switch coverage. For example, if you enroll in Original Medicare on January 12, your coverage will begin February 1.

Changing from Medicare Advantage to Original Medicare plus Medigap

There are generally only a few situations that allow you to leave a Medicare Advantage plan and pick up a Medigap plan without being subject to medical underwriting.

Medical underwriting is a practice in which a healthcare policy may exclude and limit services or charge you increased premiums based on your health history.

If you are unhappy with the Medicare Advantage plan you purchased when you first became eligible for Medicare, you have special rights to return to Original Medicare and purchase a Medigap policy within 12 months of joining Medicare. If you are moving to a different state or within a state and your Medicare Advantage policy does not cover your new area, you may also have special rights to return to Original Medicare and purchase a Medigap plan.

Note: If you have Original Medicare with a Medigap policy, change to a Medicare Advantage policy, and then decide you want to go back to Original Medicare, you may not be able to enroll in the same Medigap policy you once had.

Switching Part D plans

Most people can switch Part D plans during the annual Open Enrollment Period between October 15 and December 7.

You may be able to switch plans at other times during these special circumstances:

• You move out of the area your current plan serves
• You enter, leave, or live in a nursing home
• Your plan changes and no longer serves your area
• You get Extra Help with your Medicare prescription drug costs

You may need to change Part D prescription drug plans because your plan changed its formulary (or list of covered drugs) during the year. Plans change their formularies for several reasons: drugs are taken off the market, generic versions become available, or there are new clinical guidelines about the use of a drug. If your Part D plan changes its formulary, it is required to provide you with 60 days’ notice.

Changing Medicare supplement (Medigap) plans

You may need to change Medigap policies if your health changes, you’re paying for benefits you don’t need, or you want to find a policy that costs less.

If you do need to change policies, you should do so within the Medigap Open Enrollment Period, or the six-month window beginning the first month you have Part B coverage. During this time, the private insurers who provide Medigap policies cannot turn you down or charge you more due to pre-existing conditions.

If you apply for Medigap coverage outside of Open Enrollment, you may be subject to medical underwriting in which the private insurance company that sells Medigap policies can exclude and limit services or charge you more for premiums based on your health history.

There are some exceptions to this rule which allow you to buy a Medigap plan outside of the Medigap Open Enrollment Period:

• You have a Medicare Advantage plan, and the insurance company has left your area
• Your Medicare Advantage plan has been discontinued or is leaving Medicare
• You have moved out of your Medicare Advantage plan’s service area
• You currently have Original Medicare, and your employer coverage is ending

Changing from Medigap to Medicare Advantage

If you have a Medigap policy and want to join a Medicare Advantage plan, you’ll need to drop your Medigap policy first.

Medigap policies cannot be used to pay Medicare Advantage copayments, deductibles, or premiums, and it is illegal for private insurers to sell you a Medigap policy if you already have Medicare Advantage. The best time to enroll in a Medicare Advantage plan is during Fall Open Enrollment (October 15 – December 7). Coverage under your new Medicare Advantage plan would begin January 1 if you enrolled during Open Enrollment.

If you later want to leave your Medicare Advantage policy, switching back to your original Medigap policy is not guaranteed. In fact, you may not be able to pick up any Medigap policy due to medical underwriting, which is where the private insurance company that sells Medigap policies can exclude and limit services or charge you increased premiums based on your health history. However, you can always enroll in Medicare Advantage during Open Enrollment regardless of any pre-existing conditions.