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Matt Kershaw & Joe Palacio

Do I need to make any changes to my Medicare Advantage plan?

If you have any questions, please call Joe Palacio at (949) 929-9908.

It’s the Annual Election Period, when Medicare Advantage users can switch plans if they’re no longer happy with the coverage their plan provides.

There are several opportunities to switch plans, but this is the main period where you can evaluate your plan to see if it still matches your needs, and switch over to another plan if you find one that would suit you better.

In this post we’ll cover what changes can happen to your plan, and how and when you can switch.

Do I need to make a change?

You might not need to make a change. But you definitely need to check whether your plan has changed since last year.

If you do nothing, your Medicare Advantage plan will automatically renew. But it might not be the same plan as last year.

Each year, Medicare Advantage plans alter, offering different coverage. So double-check that your plan still covers all the things you need, and leave time to make changes if you need to.

Am I still on the right Medicare Advantage plan?

It’s important to check that you’re still on the right plan for you. Changes to what your plan covers mean you need to check every time you renew it.

In particular:

  • Your plan might not cover your chosen doctor anymore
  • Your plan’s premiums might rise
  • Your plan might not cover your medications anymore

How will I know what changes are coming to my plan?

Every fall, you’ll receive an Annual Notice of Change (‘ANOC’) about your plan. This should come to you from your provider through the mail.

It lists any changes to your benefits or plan rules. These can include:

  • If the insurance company that sponsors the plan is changing the name of the plan
  • If the plan is increasing or decreasing its service area
  • If the plan charges for premiums, deductibles, copayments, and/or coinsurance are changing
  • If the prescription drugs the plan covers are changing or are being switched to different tiers so that your cost-sharing changes
  • If the plan benefit design is changing. For example, the plan may begin or cease offering additional prescription drug coverage during the coverage gap (sometimes referred to as the ‘donut hole’).
  • If restrictions on prescription drugs are about to change. This could be prior authorizations, quantity limits or step therapy.
  • If the formulary (the list of prescription drugs covered by the plan) is about to change. This can change at any time, not just during the fall. If it does, you should receive notice in advance from your provider.

Plans can change at any time, and changes in what’s covered can affect whether the plan you’re on still suits your needs, so read your ANOC carefully.

If it doesn’t arrive by the first week of October, try contacting your provider to check and request a resend. You can find the details of your provider on the back of your plan membership card.

Can’t find your membership card? Search your supplier’s company name + contact:

That should give you their switchboard number and a contacts page that will have more useful info, like a number to call to request a letter.

Once you receive your ANOC, you can compare the plan you’re being offered for the year ahead with other plans and switch if you find one that suits your health needs better.

If you have received your notification and the changes mean your plan’s no longer a good fit for your needs, read on to find out how to switch plans.

Understanding Medicare enrolment periods

There are many types of Medicare Advantage enrollment periods that apply to everyone: Annual Election Periods and Open Enrolment Periods. There’s also the Medicare Initial Enrolment Period when you turn 65 or first become eligible for Medicare. Finally, certain changes in your personal circumstances can trigger a Special Election Period at any time of the year, giving you a window to make changes you need.

Annual Election Periods

You can change Medicare plans every year during the Annual Election Period (‘AEP’), which runs from October 15 to December 7 yearly. New coverage begins on January 1st of the following year. This is the standard way to switch plans if you need to.

During this period you can:

  • Switch from original Medicare to Medicare Advantage, or from Medicare Advantage to original Medicare
  • Switch from one Medicare plan to another
  • Enroll in a Part D prescription drug coverage plan for the first time, though in some cases a late enrolment fee may apply: these apply if you’ve gone 63 days or more without a Prescription Drug Plan or Medicare Advantage plan that offers prescription drug coverage
  • Switch from one Part D plan to another
  • Drop your Part D coverage altogether; note that you won’t be able to pick up Part D coverage again until the following year’s annual enrollment period, and that you might be subject to a late enrolment fee when you do.

It’s best to carefully read your ANOC, determine which plan suits your needs best and sign up in plenty of time.

Open Enrolment Periods

Finally, there’s a new enrollment period type in 2019, the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31, allowing you to switch to another Medicare Advantage plan if you missed the AEP.

If you have a Medicare Advantage plan with or without prescription drug coverage, you can switch during the Open Enrollment Period. You can switch to an Advantage plan, with or without prescription drug coverage; or you can switch to original Medicare, with or without part D.

If you’re an original Medicare user you cannot switch during the Open Enrolment Period.

Medicare Initial Enrollment Period

The IEP begins with the first day of the third month before the month in which a person first meets the Part B or Premium-Part A eligibility requirement and ends 7 month later, e.g., the IEP for those turning 65 begins 3 months before the month of their 65th birthday and ends the three months after the month of their birthday.

Special Enrollment Periods

There are also provisions under Medicare Advantage to let you change your plan outside both these periods in certain special circumstances.

These periods are called Special Enrollment Periods (‘SEP’) and circumstances they apply to can include:

  • If you change address outside of your current service area
  • If you lose your current employer group or union coverage including COBRA
  • If your circumstances change such that you qualify or disqualify for Medicaid
  • If you qualify for Extra Help to pay for Medicare Part D coverage through the Social Security Administration

SEPs are there to let your coverage catch up with your life, because you don’t know when you might change jobs or move house or when other circumstances in your life might change.

SEPs can be complicated because they are triggered by your circumstances rather than occurring at certain times in the year.

Usually an SEP will last for two months after an event that triggers it. To find out more, contact your provider.

How to switch Medicare Advantage plans

Switching to a new Medicare Advantage plan is simple. Just sign up to the plan that suits you best. You’re automatically unenrolled from your old Medicare Advantage plan when you sign up for your new one.

Call Joe Palacio at (949) 929-9908 for a full benefit analysis.

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