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Medicare insurance plans change year-to-year. That's why it is important to review your Medicare Advantage Plan to make sure it continues to meet your needs. You should evaluate your plan at least once a year:
- In the fall during the Open Enrollment Period (October 15 through December 7) Or
- At the beginning of the year during the Medicare Advantage Disenrollment Period (January 1 to February 14)
Evaluating Your Plan
Consider your costs
- If your current Medicare Advantage Plan has a low monthly premium and a high deductible, are you paying more out-of-pocket than you expected?
- Is your healthcare affordable, or do you have trouble meeting your copays or coinsurance amounts?
- Are you able to afford your medications?
If you are having a tough time meeting your healthcare costs, you may want to compare your plan with other Medicare insurance plans, including other Medicare Advantage Plans (also called Medicare Part C plans).
How about your healthcare dollars — what are you spending the most on this year?
- If you spend the most money on your prescriptions, consider looking for a plan with lower drug copays or a plan that provides your drugs at the lowest cost.
- If you spend the most money on office visits to specialists, compare plans to find out which one has the lowest copay for specialists.
- If you are relatively healthy and spend the majority of your healthcare dollars on your monthly premiums, consider whether a plan with a higher deductible would provide lower overall costs.
Consider your access to care
Has anything changed recently in how you receive your Medicare services? For example:
- Did your doctor stop accepting your plan?
- Did your specialist retire?
- Have you received a diagnosis that requires care by a specialist, but your plan doesn't offer enough choices for providers in your area?
If your Medicare Advantage Plan makes it difficult to get the Medicare services you need, you may want to compare plans to see which plan offers the most choices for healthcare providers in your area.
Consider changes due to healthcare reform
Under the 2010 healthcare reform law, all Medicare Advantage Plans must limit the amount of money you have to pay out-of-pocket (OOP) for your Medicare services. In 2012, the OOP limit is $6,700 for the year. No plan can ask you to pay more than this amount for covered services. But keep in mind that plans can set a lower limit, so you may want to consider a plan with a lower OOP limit.
The healthcare law also expands the services of many Medicare Advantage Plans. For example, you may find that a less-expensive plan that didn't previously offer the service you needed now offers it. So even if you are happy with your Medicare Advantage Plan, it is a good idea to compare your plan with the others available in your area to make sure you are still getting the best deal.
Deciding What to Do Next
If your Medicare Advantage Plan no longer meets your needs
If you decide your plan no longer meets your health or budget needs, you can make changes during the Medicare Advantage Disenrollment Period or Open Enrollment Period.
You can leave your plan from January 1 through February 14
- This period is called the annual Medicare Advantage Disenrollment Period.
- During this time, you may leave your Medicare Advantage Plan and go back to Original Medicare (Part A and Part B).
- If you return to Original Medicare, you can also enroll in a Medicare prescription drug plan (Part D) during this period.
- Your new Medicare insurance will take effect on the first day of the month after you enroll.
- You cannot switch plans or join a Medicare Advantage Plan for the first time during the Disenrollment Period.
You can join, switch, or leave any plan from October 15 through December 7
- This period is called the annual Medicare Advantage Open Enrollment Period or Annual Election Period.
- During this time, you can join, switch, or leave any Medicare Advantage Plan.
- You can also return to Original Medicare and buy a Medicare Part D plan during Open Enrollment.
- Your new Medicare insurance will take effect on January 1 of the following year.
If your Medicare Advantage Plan still meets your needs
If you are happy with your current Medicare Advantage Plan, you do not have to worry about doing anything. Unless your plan leaves your service area or stops contracting with Medicare, you can stay with the plan you know and trust.
However, keep in mind that plan offerings and costs may change each year. To make sure your Medicare Advantage Plan will continue to meet your needs, you should review your plan and compare it to other Medicare insurance coverage—including Original Medicare—every fall or at the beginning of the year. By comparing your coverage options, you can ensure you continue to receive the Medicare services you need at the price that is right for you.
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