Choosing Medicare coverage shouldn’t be a one-and-done decision. Plans and costs can shift every year, and so can your health needs. That’s why evaluating your health care coverage based on a variety of factors, such as convenience and cost, can be a smart move both financially and health-wise.
When you’re ready to switch up your coverage, you’ll want to consider what options best suit your health care needs and budget. With so many choices, making a change may seem overwhelming, but it doesn’t need to be. When considering what kind of Medicare coverage you want, be sure to spend time preparing. Acquaint yourself with the process so you fully understand when, how and why to consider changing Medicare plans.
Switching from Original Medicare to Medicare Advantage
Changing from Original Medicare coverage to a Medicare Advantage policy can give you more flexibility and lower your monthly costs. Medicare Advantage plans, or Medicare Part C, offer everything Original Medicare does, plus more.
These plans operate similar to an individual or employer plan. The advantage is that most include prescription drug coverage and extras, such as dental coverage and gym memberships, as well as services. Medicare Advantage plans tend to have lower premiums — some as low as $0 — and a network of doctors. Some also offer out-of-network coverage.
When can you switch from Original Medicare to Medicare Advantage?
If you’re enrolled in Original Medicare and interested in making changes to your Medicare plan, you can typically only do this once a year. During the Annual Election Period (AEP), which is every fall between Oct. 15 and Dec. 7, you can switch from Original Medicare to a Medicare Advantage plan, or vice versa. Coverage will be effective on Jan. 1.
There is also a built-in safety net for circumstances that are often beyond your control that allow you the flexibility to switch from Medicare Advantage to Original Medicare or enroll for the first time. The Special Election Period (SEP) gives you the opportunity to change your Medicare Advantage (Part C) and prescription drug (Part D) plans or go back to Original Medicare (Parts A and B) outside of the normal time restraints.
Situations that qualify for SEP might include a move outside the area your current plan covers, becoming eligible for a low-income subsidy, losing creditable prescription drug coverage from your employer or if your plan is no longer available.
Can you switch Medicare Advantage plans?
Yes, you can switch Medicare Advantage plans. Simply join the plan of your choice during one of the enrollment periods. After you select, you’ll be disenrolled automatically from your old plan when your new plan’s coverage begins.
Medicare Advantage plans work similar to an individual or employer HMO or PPO plan, helping lower out-of-pocket costs with predictable copayments and smaller deductibles. You can save money by seeing a doctor within the plan’s network.
If you are enrolled in a Medicare Advantage plan, you have multiple opportunities to re-evaluate your coverage during the Medicare Advantage Enrollment Periods. First, there is the Annual Election Period from Oct. 15 through Dec. 7. Anyone eligible for Medicare can change plans during this time.
Beneficiaries on a Medicare Advantage plan can also make a one-time change to a new plan or carrier, or switch back to original Medicare, during the Open Enrollment Period (OEP) from Jan. 1 to March 31. This option is only available for those on a Medicare Advantage plan.
There is also an Initial Election Period, or IEP, for new Medicare beneficiaries who enroll in a plan during the first three months in which they are eligible for Medicare.
Can you switch from Medicare Supplement (Medigap) to Medicare Advantage?
Yes. There can be good reasons to consider switching your Medigap plan. Maybe you’re paying too much for benefits you don’t need, or your health needs have changed and now you need more benefits.
Starting with Medigap can be a wise strategy because you are guaranteed enrollment when you are first eligible for Medicare at age 65. This way you can try out this coverage and see if it fits your budget and your health needs, which might be evolving.
Every fall during AEP between Oct. 15 and Dec. 7, you can make the switch to Medicare Advantage.
Medicare Supplement Insurance plans cover some or all of your out-of-pocket expenses from Original Medicare, such as copayments, coinsurance and deductibles. These plans do not cover any costs associated with prescription drugs under Part D and can’t be used for out-of-pocket costs under Original Medicare. These plans are standardized by the federal government, so coverage will be the same, no matter which insurance carrier you choose. There are 10 standard Medigap plans, but not every insurance company offers every plan.
Can you switch from a Medicare Advantage plan to a Medigap plan?
You can switch from Medicare Advantage to Medigap, as long as you meet certain requirements. You may have chosen Medicare Advantage and later decided that you’d rather have the protections of Medigap that go along with Original Medicare.
What’s important to remember is that two Medicare plans do not work together. If you enroll in a Medigap plan, you can’t sign up for a Medicare Advantage policy, or vice versa.
When can I switch from Medicare Advantage to Medigap?
If you are enrolled in a Medicare Advantage plan, you have the option between Oct. 15 and Dec. 7 to leave your plan and return to Original Medicare during AEP, or you can make a one-time change during OEP, Jan 1. to March 31. Another option is to switch to a different Medicare Advantage plan.
Medigap plans don’t have associated networks, so you’ll be able to go to any provider who participates in Medicare, anywhere in the United States. However, Medigap plans do not include prescription drug coverage, which means you’ll have to purchase a Part D prescription drug plan separately.
Once you’ve left your Medicare Advantage plan and re-enrolled in Original Medicare, you are generally eligible to apply for a Medicare Supplement Insurance plan.
How do I switch from Medicare Advantage to Original Medicare?
If you are enrolled in a Medicare Advantage plan, you can leave your plan and return to Original Medicare and buy a Part D prescription drug plan to supplement your Original Medicare. As of 2019, you also have the option to switch to a different Medicare Advantage plan during OEP.
Contact your current plan or call Medicare at 1-800-MEDICARE. During the Open Enrollment Period (OEP), you can switch from a Medicare Advantage plan to Original Medicare. Your coverage will start on the first day of the month after the month in which you switch coverage.
Can I switch from Medigap to Medicare Advantage?
Switching from Medigap to Medicare Advantage may save you money in monthly costs since Medigap plans tend to have higher premiums than Medicare Advantage plans. However, Medicare Advantage plans often cover fewer expenses than Medigap — potentially resulting in more out-of-pocket expenses.
Medigap plans work with your Original Medicare to help pay for most or all of your out-of-pocket costs, such as copayments, coinsurance and deductibles that Original Medicare doesn’t cover. This plan gives you more flexibility when it comes to doctor choice as well because you can go to anyone who accepts Medicare.
Advantage plans tend to be a great option for Medicare-eligible individuals who are looking to save money each month, but tend to have lower coverage needs. Typically, with any health insurance plan, the lower the premium, the higher the deductible. Since an Advantage plan would entail a $0 premium, you could be paying more, especially factoring in aspects like prescription costs.
Know your Medicare options
The more you know about your Medicare options, the easier it will be to make the right decision for you and your healthcare needs. Fortunately, there are many tools available to help you understand your options and choose the plan that fits you best. Medicare.gov is a great place to start for answers to your most basic Medicare questions.
Insurance providers also have resources that can help you understand all you need to know about Medicare, like the Medicare for Dummies guide offered by Priority Health. Priority Health offers quality coverage with built-in benefits like vision, dental and hearing coverage, and a free fitness membership. Learn more at PriorityMedicare.com.