Your Money
GET THE BEST FROM MEDICARE ADVANTAGE
If you’re among the 51 percent of Medicare beneficiaries who have a Medicare Advantage (MA) plan, now’s a good time to ask whether your coverage still meets your needs. During the fall open enrollment season (Oct. 15–Dec. 7) and MA open enrollment season (Jan. 1–March 31), you can change MA plans or return to original Medicare (OM) and add a drug plan. Here’s what you need to know about switching.
IF YOU WANT A DIFFERENT MEDICARE ADVANTAGE PLAN...
DO THIS!
☐ Use the Medicare Plan Finder to compare plans by provider access, cost and coverage. Health maintenance organizations (HMOs) cover out-of-network care only in limited situations; preferred provider organizations (PPOs) cover out-of-network treatment, but it’s usually costlier than staying in-network.
☐ Call your preferred health care providers to see if they accept any MA plans and are taking new patients. Don’t rely on plans’ provider directories, which may be outdated.
☐ Contact plans directly to ask about provider networks, referrals, preapproval requirements, copays and drug coverage limits.
DO THIS!
☐ Check listings in the Medicare Plan Finder to compare plans. It can rank plans based on premiums plus drug cost.
☐ Look for lower copays if you require frequent services, even if premiums are higher; compare plans’ annual out-of-pocket max.
☐ Consider a low-premium plan with higher service copays if you rarely need services.
DO THIS!
☐ Respond “Yes” in the Medicare Plan Finder when asked “Do you want to see your drug costs when you compare plans?” and enter the drugs you use. After you select “Plan Details” for any plan, scroll down and click on “View more drug coverage” to see if your medications are covered and whether they have restrictions.
☐ Contact your top plan choices to confirm that your drugs are covered for your diagnosis.
DO THIS!
☐ Filter plans by star ratings in the Medicare Plan Finder, or look for the rating under each plan name.
DO THIS!
☐ Prioritize provider access, coverage and costs rather than choosing a plan only for its extra benefits.
☐ Use the “Plan Benefits” filter in the Medicare Plan Finder to see available extras.
☐ Call each plan to verify limitations and eligibility requirements for its extra benefits.
IF YOU WANT TO SWITCH FROM MEDICARE ADVANTAGE TO ORIGINAL MEDICARE…
THERE’S A CATCH …
You may not be able to add Medicare supplement insurance, or Medigap, which can cover costs that OM doesn’t. In most cases, insurers can charge higher premiums because of a preexisting condition (diabetes, heart disease or cancer, for example) or deny an application altogether. That means you could face unlimited out-of-pocket costs for deductibles, copays and coinsurance, which Medigap usually covers.
… BUT THERE ARE EXCEPTIONS …
If you’re switching from MA to OM, you have “guaranteed issue” in the following situations, meaning insurers must write you a Medigap policy at standard rates:
▶︎ You live in Connecticut, Maine, Massachusetts or New York, which require guaranteed-issue Medigap plans to be offered to all OM enrollees 65 and older.
▶︎ You first got Medicare less than 12 months ago.
▶︎ You dropped Medigap to try MA for the first time less than 12 months ago, and you want to return to that same Medigap plan.
▶︎ Your MA plan is canceled or terminated. (Apply for a Medigap policy within 63 days of coverage ending.)
▶︎ You move out of your plan’s service area. (Again, apply within 63 days.)
▶︎ You live in one of the 29 states that mandate guaranteed-issue Medigap plans if your retiree coverage changes, or in one of the 10 states with such a mandate if you lose Medicaid. (For listings, go to kff.org, search for “Medigap elusive” and click on that article’s appendix.) Check with your state for specific rules.
… SO BEFORE YOU MAKE THE MOVE
▶︎ Contact your state insurance department or local SHIP office to review your options and understand your state’s Medigap rules.
▶︎ If you have had an MA plan for more than a year, apply to several Medigap plans to see if any of them will offer you coverage.
ESSENTIAL RESOURCES
AARP on Medicare Read the latest news, find answers to common questions and get instant responses to queries from a tool drawing on AARP’s vast knowledge base. aarp.org/medicare
Medicare Plan Finder Compare all the plans in your area with this official Medicare tool. It has information on each plan’s costs, coverage and extra benefits. medicare.gov/plan-compare
State Health Insurance Assistance Program (SHIP) Get free, objective counseling on Medicare choices and coverage from staff or local volunteers. shiphelp.org
1-800-MEDICARE (800-633-4227) is available 24/7 (except on some federal holidays) to help you compare your coverage options. The phone number for TTY users is 877-486-2048.