6 Reasons to Make a Change to Your Medicare Advantage Plan

From January 1 to March 31, those enrolled in a Medicare Advantage plan can make a change.

Whether that’s moving to a different MA plan or switching back to Original Medicare with a supplemental policy and a drug plan, you can essentially change your mind during this Open Enrollment Period for Medicare Advantage (MA OEP).

From a doctor leaving your network to realizing the out-of-pocket costs aren’t aligned with your needs, here are 6 reasons to make a change to your Medicare Advantage plan.

Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

1. Your doctors or specialists aren’t in-network.

Many Medicare Advantage plans can seem very attractive when you read about the perks, and it’s easy to go ahead and sign up!

However, if you don’t check the in-network list of doctors and specialists, you might be in for a surprise. Under many Medicare Advantage plans, doctors and specialists who are out-of-network may be completely uncovered or will have a higher coinsurance and copayment.

If you realize between January 1 and March 31 that one of your key doctors or specialists is not covered under your new plan, you can utilize the Medicare Advantage Open Enrollment Period (MA OEP) to make a change.

Please note you can only make one move during this special enrollment window, so choose wisely!

2. You don’t want a managed care plan.

Medicare Advantage plans are managed care plans, meaning the insurance provider has a certain amount of say in what treatments and medications you can take for different ailments.

This is unlike Original Medicare and Medicare Supplements, which are fee-for-service, not managed care.

The managed care component can be very frustrating in certain situations because your doctor may want to explore one line of treatment, but your plan requires you to try something less expensive first.

Wanting your doctor to have full control over your treatment options is often a reason individuals decide to switch back to Original Medicare with a supplement.

Dr. Jacob D. Sams, MD, an orthopedic surgeon, says he often clashes with Medicare Advantage plans that won’t allow him to treat his patients as he wants to:

“I’ll never forget a patient that was told a bunch of misleading things, and when the time came for surgery, their MA plan basically said they hadn’t suffered enough and had to do several more weeks of therapy,” he shared with us.

While Medicare Advantage plans can be a great fit for some, it’s important to be aware of the managed care component.

3. You don’t want to get referrals to see specialists.

Most Medicare Advantage plans require you to have a primary care physician (PCP) who coordinates all your care. If you want to see any kind of specialist, you’ll need to visit your PCP first and get a referral.

Cardiologists, neurologists, urologists, orthopedic doctors, physical therapists… you’ll need a referral each and every time.

If this is frustrating or an inconvenience, you may want to switch back to Original Medicare with a supplemental policy.

4. Your prescriptions aren’t covered by the plan.

Most Medicare Advantage plans come with drug coverage included. These are called Medicare Advantage Prescription Drug plans, or MAPDs.

While you may love the benefits that come with the health part of your plan, you’re somewhat stuck with whatever drug coverage is wrapped into the plan. If it’s not compatible with your medication list, your out-of-pocket costs may be quite high at the pharmacy.

Our agents can run a plan comparison using your exact list of drugs and dosages to ensure your plan is compatible. If not, you may want to go back to Original Medicare with a supplement and a Part D drug plan.

5. You realized there’s a more competitive plan available in your county.

According to the Kaiser Family Foundation, around 7 in 10 Medicare beneficiaries don’t compare plans during the fall enrollment period.

Many individuals think they don’t need a need to shop the market, because they were satisfied with their plan from last year.

However, Medicare Advantage plans may change every year. You will get a notice sometime in September outlining these changes, but it’s easy to miss. After all, folks on Medicare get a LOT of mail and advertisements!

If you realize something about your plan changed – or you just want to see what else is available – reach out to us and we will help you compare the options. May the best plan win!

6. You don’t want the risk of high out-of-pocket costs.

While Medicare Advantage plans have low costs in the short-term, you could be facing thousands in out-of-pocket costs should you get sick or require a stay in the hospital.

With a Medicare Supplement plan, you do have higher monthly premiums, but your out-of-pocket costs are $0 on a Plan F and just $203 on a Plan G ($203 is the deductible in 2022). If you get sick or need to stay in a hospital, you won’t be facing big medical bills when you have a Medigap plan.

With a Medicare Advantage plan, on the other hand, your monthly premiums may be very low or even $0 per month, but you pay when you need care. According to KFF.org, a 6-day hospital stay on an average Medicare Advantage plan would cost $1,763.

Unfortunately, you should not wait until you develop a condition or illness to try to switch from a Medicare Advantage plan to a Medicare Supplement plan. After your initial enrollment period, you do need to pass medical underwriting, and you may not qualify if you have a pre-existing condition.

It’s better to compare your options while you’re still healthy and can pass health questions. If you’re leaning towards leaving your Medicare Advantage plan, do it as soon as possible.

Conclusion

Medicare Advantage plans can be a perfect fit for many individuals, but it’s still important to understand some of the drawbacks.

If you decide you’re not happy with your Medicare Advantage plan, you may be able to make a change.

Reach out to our office to ensure you know your options and can get the help you need. You can schedule an appointment online or give us a call at 217-423-8000.