Is Your Medicare Advantage Plan Not Working for You?
by: Will Rahjes
If you turned on the television during Medicare Open Enrollment, you likely heard a marketing pitch for Medicare Advantage. Although Medicare Advantage may be a good choice for some, the upfront lower cost may not pan-out to be the best option for others. For example, those living in a rural area where there are fewer doctors and hospitals, may experience a lack of providers in the Advantage plan network that could be a barrier to getting care. If you signed up for Medicare Advantage and it’s not the advantage you thought it to be, you may have options.
Below are various scenarios which may allow you to switch back to original Medicare with a Medigap policy without getting a financial penalty:
- Your first year in a Medicare Advantage plan. If this is your first time in a Medicare Advantage plan you can switch to original Medicare and Medigap within 12 months of your Advantage plan start date. This option is also called your “trial right” and it exists to protect those who have found out that Medicare Advantage is not the best option for them. Exercising your Medicare Advantage trial right privilege will also grant you guarantee issue rights, where a Medigap insurance company cannot deny your application.
- During the OEP (Open Enrollment Period) for drug coverage. This enrollment period runs from October 15 to December 7 each year and is for all Medicare plans, including Medicare Advantage and Medicare prescription drug coverage. You can return to original Medicare at this time; However, if you previously had prescription drug coverage through Medicare Advantage, you would need to enroll in a Medicare Part D plan to maintain the prescription drug coverage.
- During the Medicare Advantage OEP. If you are unhappy with your Medicare Advantage plan, you can change it or drop it for original Medicare between January 1 to March 31. You can also join a prescription drug plan and purchase a Medigap policy during this time. Keep in mind that you cannot switch from original Medicare to Medicare Advantage during this time. It is also not an option for a person to enroll in new prescription drug coverage or switch prescription drug coverage if they’re already enrolled in original Medicare.
- During special enrollment periods (SEP). SEPs are periods during which a person can usually make changes to their Medicare plan without incurring a financial penalty. You can usually make changes to your Medicare plan without a penalty if changes like these apply to you:
- You move to a new zip code
- You move back to the U.S. after living in another country
- You move into or out of a skilled nursing facility or long-term care hospital
- You have reached the end of your jail sentence
If you are still unsure whether or not you or a loved one meets the SEP criteria, you can always give us a call or visit Medicare.gov to review more information. To learn more about Medicare, you can view our informational videos on our YouTube Channel by clicking here.
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