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ARE YOU UNHAPPY WITH YOUR MEDICARE COVERAGE?

“Medicare Open Enrollment is October 15 to December 7. If you’re unhappy with your current coverage, now is the time to switch Medicare policies.”

Every year Medicare beneficiaries have 53 days to join, switch or drop Medicare plans. We refer to these seven and a half weeks as the Medicare Annual Election Period or Medicare Open Enrollment.

This is the only time you can make changes to your Medicare coverage outside of your Initial Enrollment Period (IEP). That is unless you qualify for a Special Enrollment Period. Your IEP is three months before and after the month of your 65th birthday.

While you can't make changes to your Original Medicare or Medicare Advantage coverage outside of the enrollment period, you can switch, add or drop Medicare Supplement plans at any time during the year. However, you may be subject to underwriting if you take action outside of the enrollment period.

With that said, it’s very important that you prepare for Medicare Open Enrollment. If you’re unhappy with the coverage you currently receive, open enrollment is the time to make changes.

On a side note, even if you are happy with your coverage, many Medicare plans change yearly. You need to know if those changes will affect the benefits you receive or the premiums you pay. Make sure to prepare for open enrollment by taking these steps.

Before we discuss your options, let’s review the different parts of Medicare. Understanding how each of these plans works will help you make the right decision.

Or, skip to one of the following sections:

  1. Unhappy with Original Medicare?
  2. Unhappy with Medicare Advantage?
  3. Medicare Supplement Insurance

THE DIFFERENT PARTS OF MEDICARE & THEIR GAPS

As a Medicare recipient, you should be familiar with Medicare Parts A-D. Here's a refresher, just in case.

ORIGINAL MEDICARE

Original Medicare includes Part A and Part B. Those who qualify for Medicare are automatically signed up for Original Medicare.

Part A (Hospital Insurance) helps cover:

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home healthcare

Part B (Medical Insurance) helps cover:

  • Services from doctors and other healthcare providers
  • Outpatient care
  • Home healthcare
  • Durable medical equipment
  • Some preventative services

MEDICARE ADVANTAGE

The government regulates Medicare Advantage, a.k.a. Part C but it's sold by private insurance companies. They must provide coverage that’s comparable to Medicare Parts A & B. They can include prescription drug coverage.

Part C (Medicare Advantage):

  • Includes the same benefits as Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D)
  • May include extra benefits and services for an extra cost
  • Run by Medicare-approved private insurance companies

PRESCRIPTION DRUG COVERAGE

Private insurance companies sell prescription drug plans (Part D) as a supplement to Medicare Parts A & B. Usually you cannot buy a Part D plan if you have a Medicare Advantage plan. But, some Medicare Advantage plans come with prescription drug coverage.

Part D (prescription drug coverage):

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and protect against higher costs in the future

No matter which Medicare plan you choose, there will be gaps in coverage. Consequently, these gaps result in out-of-pocket costs. These costs may include co-payments, inpatient care, dental services, prescription drugs and deductibles.

While there are supplemental plans that can help cover some out-of-pocket costs, they may not be right for you. It’s up to you to figure out which combination of Medicare parts and supplemental plans works with your health, budget and risk tolerance.

To simplify the process, we’ve outlined your options below. They're listed depending on whether you currently have Original Medicare or Medicare Advantage.

UNHAPPY WITH ORIGINAL MEDICARE?

If you’re unhappy with your Medicare Part A or B, you have several different options:

  1. Keep Original Medicare and add or switch Medicare Supplement plans.
  2. Keep Original Medicare and add or switch prescription drug plans.
  3. Drop Original Medicare and switch to Medicare Advantage.

As you can see, you don’t have to drop Original Medicare if you’re unhappy. The first two options above allow you to keep your current plan. But is keeping Part A and B the right choice?

Ask yourself these questions when deciding if you should keep Original Medicare or switch to Medicare Advantage:

Will there be additional monthly premiums, and can you afford them?

Since they’re private plans, Medicare Advantage and Medicare Supplement plans usually charge a monthly premium. With Medicare Advantage, you’re also responsible for the Medicare Part B premium. The question then is which solution offers the benefits you need at the best price.

Are you ok with being restricted to a network of providers?

Remember how we mentioned Medicare Advantage plans are sold by private insurance companies? Well, they may also restrict you to a network of providers.

But, any provider that accepts Medicare must also accept Medicare Supplement.

That means more doctors accept Original Medicare and Medicare Supplements than Medicare Advantage.

So, if you travel often or like the flexibility of changing providers, you should stay away from Medicare Advantage. Instead, stick with Original Medicare while considering a supplemental plan.

Do you need to see specialists often?

Original Medicare does not require a referral from your primary care doctor to see a specialist. Medicare Advantage HMO plans will require you to get one. And while a Medicare Advantage PPO may not require you get a referral, you will likely pay more to see a specialist.

Are you currently employed?

If you receive healthcare coverage from your employer, you could risk losing it by switching to Medicare Advantage. And, if you receive retiree benefits from your employer, those benefits would not apply to Medicare Advantage. You should check with your company’s HR department for more information.

Are you prescribed a lot of medications?

Do you have trouble covering the cost of prescription drugs? If so, have you considered supplementing your Part A and Part B coverage with a Part D plan?

If you already have Part D and still have trouble covering the costs, you may want to consider switching to a Medicare Advantage plan that offers prescription drug coverage.

If you’ve decided to keep your Original Medicare plan but think Medicare Supplement insurance can help you get the coverage you want, skip to the Medicare Supplement section.

UNHAPPY WITH MEDICARE ADVANTAGE?

If you’re unhappy with your Medicare Advantage plan, you have several options:

  1. Switch Medicare Advantage plans.
  2. Drop Medicare Advantage and switch to Original Medicare.
  3. Drop Medicare Advantage, switch to Original Medicare and purchase Medicare Supplement insurance.

You don’t have to drop Medicare Advantage if you’re unhappy with your current plan. You can switch to a Medicare Advantage plan that is more suited to your needs and budget. Once you select a new plan to enroll in, you’ll be automatically disenrolled from your old plan. But how do you know that sticking with Medicare Advantage is the right move?

Ask yourself these questions when deciding whether to keep Medicare Advantage or switch to Original Medicare:

Do you need help paying out-of-pocket costs?

While Original Medicare doesn’t have an out-of-pocket maximum, Medicare Advantage does. The government mandates that the limit is no more than $6,700 a year. That means all covered expenses after that are 100 percent paid for.

What if you can’t afford $6,700 in out-of-pocket expenses? Then, you should consider switching to Original Medicare and purchasing a Medicare Supplement (Medigap) policy. Medigap insurance may pay up to 80 percent of covered out-of-pocket costs not paid for by Original Medicare.

Although, you cannot purchase Medicare Supplement insurance if you have Medicare Advantage. So, make sure you’ve taken into consideration all copays/coinsurance, premiums and deductibles to determine if switching to Original Medicare is the right move.

Are you happy with your coinsurance/copays?

How much are you paying for coinsurance or copays? Original Medicare charges 20 percent coinsurance for most services. If this is less than you’re currently paying, you may want to consider switching to Original Medicare. What if you switch to Original Medicare and add supplemental insurance? Would your coinsurance and premiums still be less?

Can you save more on premiums?

Remember, Medicare Advantage is private health insurance. Therefore, most Medicare Advantage plans charge a premium. And with a Medicare Advantage plan, you’re still responsible for paying for Part B premiums. If you’re currently paying a premium for your Medicare Advantage plan, make sure to compare the costs. Ultimately, you want to know what costs more. Original Medicare plus Medicare Supplement premiums or Medicare Advantage premiums plus Part B premiums?

Do you need access to a larger network of providers?

Does your Medicare Advantage plan restrict you from seeing providers outside its network? Most Medicare Advantage plans do. They also usually require referrals and may charge more to see specialists.

On the other hand, most healthcare providers accept Medicare. And those who accept Medicare must also accept Medigap policies.

If you’re happy with the providers in your network and don’t see specialists often, sticking with Medicare Advantage may be the right decision. But if you see specialists often or need to switch providers often, you may want to consider switching to Original Medicare.

Are you prescribed a lot of medications?

If you’re prescribed a lot of medications, a Medicare Advantage plan may be right for you. Most Medicare Advantage plans include prescription drug coverage. If yours doesn’t offer drug coverage and you need it, you can switch to a plan that does. Or you can switch to Original Medicare and add Part D coverage.

If you’re not prescribed a lot of medications and don’t have any issue covering those costs, you should check to see that you’re not paying more for a Medicare Advantage Prescription Drug Plan that you don’t need.

Don’t forget. If you currently have Medicare Advantage but would like to switch to Original Medicare, you must make the change during Medicare Open Enrollment or during the Medicare Advantage Disenrollment Period (Jan. 1 – Feb. 14).

MEDICARE SUPPLEMENT INSURANCE

You may have noticed we mentioned Medicare Supplement insurance several times already. Medicare Supplement or Medigap insurance is a supplemental policy that covers some of the costs of Original Medicare Parts A & B. These are private plans. You can't purchase them if you have Medicare Advantage.

SHOULD YOU HAVE MEDIGAP INSURANCE?

There are a couple circumstances where you might want to purchase Medigap insurance:

  1. You currently have Original Medicare Part A and Part B. And you’ve decided Medicare Advantage isn’t for you, but you would like to spend less on out-of-pocket costs.
  2. Or, if you currently have Medicare Advantage and you’ve decided that switching to Original Medicare and supplementing your plan with Medigap will save you money.

Thinking about dropping Medicare Advantage so you can pick up Medicare Supplement insurance? There are two situations that allow you to do so without being subject to underwriting:

  • If you switch from Medicare Advantage to Original Medicare within 12 months of joining Medicare Advantage. That is as long as you joined Medicare Advantage during your initial enrollment period.
  • If you move to an area not covered by your Medicare Advantage plan.

For more information on how Medicare Supplement insurance can help cover your Medicare gaps, read this.

HOW TO CHOOSE THE RIGHT MEDIGAP PLAN

Currently, there are 10 types of Medicare Supplement plans. Each plan type offers different benefits with some plans being more comprehensive than others.

Every healthcare provider that accepts Medicare must also accept Medigap insurance. However, they don’t have to accept all plan types.

For help deciding which plan type is right for you, check out this information.

HOW TO SWITCH MEDIGAP PLANS

Do you currently have Medicare Supplement insurance but want to pay less for premiums? Or do you need more or less coverage? You have options.

You can switch Medigap plans. But first, you’ll need to shop around. Use our Medigap Multi-Quote Tool to compare rates from top carriers in your area, instantly.

To learn more about how you can save the most on Medigap insurance, read this.

FINAL THOUGHTS

Whether you have Original Medicare or Medicare Advantage, you have the power to change your coverage. If you aren’t happy with your current Medicare coverage, now is the time to act.

Ensure you’re ready for Medicare Open Enrollment. Review your choices and determine what’s best for you according to your budget, health needs and risk tolerance.


Want more advice on what to do if you’re unhappy with your Medicare coverage? Give us a call at 844.847.3800 to speak with a licensed insurance specialist.

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