Unhappy with your Medicare Advantage plan? You have until March 31 to make a change, thanks to an under-the-radar enrollment period.
During this Medicare Advantage Open Enrollment Period, which happens annually, you can switch to a different Medicare Advantage plan or leave the program altogether and enroll in Original Medicare. (People currently on Original Medicare can't make a change during this time. If you don't like your coverage, you generally have to wait until the fall annual open enrollment period to pick a new plan for 2023.)
Also known as Part C, Medicare Advantage is a private plan alternative to Original Medicare, which is run by the federal government. In 2021, around 42% of the total Medicare population, or more than 26 million people, were enrolled in a Medicare Advantage plan, according to the Kaiser Family Foundation. These plans have become popular in part because many offer coverage that Original Medicare doesn't, including limited dental coverage and gym memberships.
Yet some Medicare Advantage enrollees might still wind up with buyer's remorse. For starters, many of these plans are HMOs, and you might want a broader choice of doctors and hospitals than your plan offers. On Original Medicare, you can visit any doctor in the country who takes Medicare, but on Medicare Advantage your choice of medical provider is often limited to those participating in the plan's network. And to visit a specialist you may need to get a referral from a primary care physician. "Make sure you understand the referral process," says Gregg Ratkovic, president, Medicare for eHealth, an online broker.
You might also encounter unexpected costs. Medicare Advantage plans are advertised aggressively during the fall open enrollment season, and many are touted as no cost. While they may have a $0 monthly premium, plans are not free. Charges for hospital co-payments are one type of expense that could surprise beneficiaries, Ratkovic says. Another unpleasant surprise could be if your prescriptions aren't covered to the extent that you'd like. While you're unlikely to find a plan that's completely no cost, you can look for one that better meets your needs.
One option is to search for Medicare plans on Plan Finder, the official site of Medicare.gov, or go through a broker. If you switch to a new Medicare Advantage plan, you'll be automatically dropped from your prior plan when your new coverage begins. To switch to Original Medicare, contact your current plan or call 1-800-MEDICARE (1-800-633-4227).
Keep in mind that supplemental "Medigap" policies don't work alongside Medicare Advantage, so you can't use the former to pay any costs incurred under the latter. If you want to switch over to Original Medicare and buy a Medigap policy to supplement it, make sure you understand the rules: unless you qualify for a "trial right" to coverage, health insurers can look at your medical records to determine whether or not to issue you a policy. They could charge you more or even reject your application, based on your conditions. Criteria vary by insurer, but poorly controlled diabetes and a current cancer diagnosis are examples of conditions that may disqualify you from buying a policy. Make sure you understand your eligibility before dropping your Medicare Advantage policy.
Medicare can be complicated. For free and unbiased help understanding your options, contact your local State Health Insurance Assistance Program.