Many folks think the Medicare Advantage Open Enrollment Period runs from October 15th – December 7th. This is actually incorrect. The term Open Enrollment has been thrown around over the years to somehow cover different enrollment periods. This is actually wrong! The dates listed above are actually for the Medicare Advantage Annual Election Period.
The Medicare Advantage Open Enrollment Period runs from January 1st – March 31st and limits the choices and changes that a Medicare beneficiary can make. During the Annual Election Period, those on Medicare have access to make changes to just about everything related to Medicare such as switching from one Medicare Advantage plan to another, switching their stand-alone Part D prescription drug plan, leaving original Medicare to enroll in a Medicare Advantage plan, or leaving a Medicare Advantage plan to go back to original Medicare.
What is the Medicare Advantage Open Enrollment Period?
The Medicare Advantage Open Enrollment Period starts on January 1st and ends on March 31st each year. During this period, you are allowed to make changes to your Medicare Advantage plan. This means you can switch from one Medicare Advantage plan to another or go back to Original Medicare.
Can I switch from original Medicare to a Medicare Advantage plan during the Open Enrollment Period?
No! Let’s say that you currently have original Medicare along with a stand-alone Part D prescription drug plan. In addition to this coverage you also have a Medicare Supplement Plan G. If you had wanted to make the change to a Medicare Advantage plan, you would have had to complete this during the Annual Enrollment Period (Oct 15th – Dec 7th).
Can I switch from a Medicare Advantage plan to original Medicare?
Yes! If you are enrolled in a Medicare Advantage plan and find that it simply is not working for your healthcare needs, then you can use this enrollment period to make a switch back to original Medicare. Keep in mind that you will need to enroll in a stand-alone Part D prescription drug plan so that you do not face any future penalties.
Is it a good idea to switch Medicare Advantage plans during Open Enrollment?
When deciding to switch from one Medicare Advantage plan to another, consider factors such as the participation of all your providers in the new plan’s network. If they do, then you need to determine what benefits do you gain by switching. Are your co-payments going to be lowered? Are you getting additional benefits in the new plan that are not available in your current plan? All of these items and more should be weighed before making a switch.
Should I switch from a Medicare Advantage plan back to original Medicare during the Open Enrollment Period?
While this is actually a common event that takes place, it is important to keep in mind several things. If you have always been on a Medicare Advantage plan for more than 12 months and decide to switch back to original Medicare and get a Medicare Supplement plan, you will need to qualify for the Medicare Supplement plan by answering a list of health questions. Qualifying for the Medicare Supplement plan is not a guarantee during the Medicare Advantage Open Enrollment period.
If you left original Medicare and a Medicare Supplement plan during the annual election period (and it is your first time enrolling in a Medicare Advantage plan), then you would be within your 12 month trial period where you could return back to original Medicare and have your existing Medicare Supplement issued with no health questions. You would also be able to sign up for a stand-alone Part D prescription drug plan.
Why are people leaving Medicare Advantage plans?
People commonly leave Medicare Advantage plans due to health status changes, network alterations such as providers no longer participating, or the requirement of prior authorization before consulting a specialist or undergoing a test. Another common reason that a beneficiary might leave a Medicare Advantage plan could be due to their prescription coverage offered within the plan. Such things as a certain prescription no longer being on the plan’s formulary or that same prescription now is a higher tier that requires the member to pay a higher amount out of pocket can have a negative impact.
What is the scandal about Medicare Advantage plans?
There are a couple of issues that have made Medicare Advantage plans look tarnished in recent years. The Centers for Medicare and Medicaid Services (CMS) have accused some Medicare Advantage plans of overcharging the government for medical services. This is simply a nice way of saying that they committed fraud.
Another issue is that complaints regarding Medicare Advantage plans increased dramatically over the last couple of years. Many folks who called into the 800#s they saw on television ads made switches into Medicare Advantage plans who didn’t completely understand the restrictions such as networks, referrals, and having to be responsible for co-pays and co-insurance out of their own pocket. According to CMS the amount of complaints rose from 16,000 in 2020 to nearly 40,000 in 2021.
New regulations have transformed the display of Medicare Advantage ads on TV, yet out-of-country rogue call centers continue to plague seniors. These call centers blatantly disregard the Federal Do Not Call List, cold call seniors multiple times a day with such bogus claims as:
- Saying they are with Medicare (CMS)
- Scammers falsely claim that a Medicare beneficiary’s current card is invalid and needs replacement with a new plastic card. Once the senior provides their Medicare ID to these callers, the scammers transfer them to a licensed US call center. Unbeknownst to the senior, the call center switches them into a Medicare Advantage plan without their knowledge or consent.
Is being enrolled in a Medicare Advantage plan the same as having a Medicare Supplement?
Absolutely NOT!! When it comes to Medicare, there are a lot of terms to keep straight. One question many people have is whether being enrolled in a Medicare Advantage plan is the same as having a Medicare Supplement, also known as Medigap. The short answer is no. While both types of plans can help cover costs that original Medicare doesn’t, they work in different ways. Private insurance companies offer Medicare Advantage plans, typically replacing original Medicare altogether. In contrast, Medicare Supplements actively fill in the gaps while working alongside original Medicare. It’s important to understand the differences between the two so you can choose the plan that’s right for you.
Is there a simple list of what I can and can’t do during the Medicare Advantage Open Enrollment Period?
Yes! Below is a list of everything you can do during the Open Enrollment Period.
- Change from one Medicare Advantage Plan to another Medicare Advantage Plan.
- Drop your current Medicare Advantage Plan and return to Original Medicare and get a stand-alone Medicare Part D prescription drug plan.
- Make a one-time-change
What you can’t do during the Open Enrollment Period
- Enroll in a Medicare Advantage plan for the first time.
- Switch your current stand-alone Part D prescription drug plan to another stand-alone Part D plan.
- Make changes more than once
Remember, the Medicare Advantage Open Enrollment Period doesn’t offer options to switch Medicare Supplement carriers without medical underwriting.
Conclusion
Review your current Medicare Advantage coverage during the Open Enrollment Period to ensure it meets your specific health care needs. If you are not sure, then you can simply contact Senior Benefit Services, Inc for a non-bias and free review. Give us a call today at (800)924-4727 or use the contact form below.
