Time is running out to switch or ditch your Medicare Advantage Plan

Don’t like your Medicare Advantage Plan? You have a couple weeks left to do something about it.

During a window that opened January 1 and will close March 31, enrollees who are unhappy with the choice they made during Medicare’s fall open enrollment period have two options: ditch it for original Medicare or switch to a different plan.

“Sometimes people just chose the wrong plan,” said Danielle Roberts, co-founder of insurance firm Boomer Benefits in Fort Worth, Texas. “Maybe they thought their doctor was in network and then discovered the person wasn’t.”

“Sometimes people just chose the wrong plan. Maybe they thought their doctor was in network and then discovered the person wasn't.” -Danielle Roberts, Co-founder of Boomer Benefits

Separately, but also possible until March 31: If you missed your initial Medicare enrollment period and don’t qualify for an exclusion, you can sign up now. In this case, coverage won’t start until July 1.

If you’re among those who already have an Advantage Plan and want to change your coverage, there are some things to keep in mind.

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For starters, because you only get one shot at this, make sure you know what you’re signing up for if you choose another plan. That includes ensuring that your medications are covered and that your favorite doctors or other providers are in-network.

Roberts said that even if you see your doctor listed on a plan’s online directory, you should confirm that status directly with their office because those listings can be outdated or contain errors.

“When you call your doctor, ask specifically if they are in network for your particular plan,” she said. “Don’t just say the name of the insurance company.”

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If you’re planning to drop your Advantage Plan in favor of original Medicare — which consists of Part A hospital coverage and Part B outpatient coverage — you also likely need to get a standalone Part D prescription drug plan. This often was included in your Advantage Plan, and life-long penalties can be applied if you go more than 63 days without coverage.

Additionally, if you’re planning to get a supplemental Medicare plan — called Medigap — to pair with original Medicare, be aware of additional rules for applying. These policies help cover costs such as deductibles, co-pays and co-insurance.

When you first enroll in Medicare (typically at age 65), you get six months when you’re guaranteed Medigap coverage. That is, you can get a policy without the insurance company nosing through your health history and deciding whether to insure you.

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After that, it can be a different story. In most states, you have to go through medical underwriting. If you’re in this situation and have underlying health issues, you could be charged more for a policy or denied coverage altogether.

“Ideally, you applied for Medigap early in this enrollment period,” Roberts said. “It could take a few weeks to underwrite you.”

Special exceptions to this rule include when your Advantage Plan is no longer available or when you’re within the first year of trying an Advantage Plan for the first time and decide to ditch it, Roberts said.

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