While every Medicare beneficiary has the opportunity to change plans during the open enrollment period, few seem to take the time to review their options. A 2021 report from the Kaiser Family Foundation found that fewer than a third of Medicare beneficiaries compared plans in 2019.
However, skipping this step could be a mistake, especially if any of the following are true.
1. You are moving
Medicare Advantage plans typically serve a specific geographic area. If you move elsewhere, it can be difficult to find providers that participate in your plan, and using out-of-network providers can raise coinsurance costs significantly.
“The plans vary, often at the county level,” Reese says.
If you expect to move out of your plan’s coverage area but not until later in the year, you may want to keep your current insurance for now. Once you leave your plan’s service areas, there is a special enrollment period that allows you to switch plans after moving in.
2. Your plan network changes
Medicare Advantage often operates as health maintenance organizations (HMOs) or preferred provider organizations (PPOs), with a list of participating providers that make up their network. However, networks do not necessarily remain the same every year.
Before renewing your current Part C plan, make sure your preferred providers and health care facilities are still in the network. Prescription drug formulas (the list of drugs covered by your plan) can also be changed. If your plan has a new prescription booklet that excludes your medication, you may want to change coverage during open enrollment for Medicare 2022.
3. You have been diagnosed with a new condition
If you have a new diagnosis, such as diabetes or cancer, talk to your healthcare provider about what you can expect for treatment in the new year. Then be sure to include any anticipated specialist or medications in your current Medicare Advantage plan.
4. Your petty cash costs increase
Sometimes a plan may change its premiums or personal costs, which can be a sign that it’s time to find new coverage. Other Medicare Advantage plans may have lower premiums, and some do not charge premiums at all.
According to Reese, “People are often drawn to[the free, premium plans]as their first choice.” Before signing up for a plan just because it doesn’t charge a monthly fee, check the co-pay requirements. Sometimes it’s better to pay a premium for a plan that covers more of your costs.
5. Want more benefits
Nearly half of Medicare recipients (45%) were enrolled in Medicare Advantage plans in 2022, according to a survey conducted on behalf of the Commonwealth Fund, an organization dedicated to improving health care systems. The survey found that nearly a quarter of those with Medicare Advantage chose such a plan because it provides additional benefits.
many Medicare Advantage Plans Providing coverage not found in original Medicare, such as vision or dental benefits. They may also offer additional benefits, such as gym memberships or transportation coverage, says Reese.
Even if you are satisfied with your current Medicare Advantage plan, it may be worth comparing your options to see if there are more or better benefits available elsewhere.
6. You want a Medigap
Medicare beneficiaries can purchase Medical supplement insurance, also known as Medigap plans, “fill in the gaps” in original Medicare coverage. They can also offer benefits not readily available through Part C, such as emergency medical care while traveling in foreign countries or additional coverage for skilled nursing facilities.
However, only those with original Medicare can purchase a Medigap policy. So if you have a Medicare Advantage plan, you will need to switch coverage to Original Medicare before you can purchase supplemental insurance.
Know that if you purchase a Medigap policy outside of the initial enrollment period at age 65, you may be subject to medical underwriting, which means that the insurance company offering the plan can adjust premiums based on your health status, which can cost you more. As a result, a Medigap plan may not be available or available to everyone because they are either denied coverage due to a health condition or are offering an unaffordable price.
7. You prefer the original Medicare program
While Medicare Advantage plans come with extras, such as coverage for additional services and fringe benefits, Original Medicare has one important advantage: It can be used anywhere.
With Original Medicare, you don’t have to worry about whether your preferred service provider or hospital is online. Among those who chose original Medicare, 40% cited more choices for doctors, hospitals and health care providers as their driving reason, according to a Commonwealth Fund survey.
People with diabetes may also want to consider the original Medicare, due to a 2023 change that sets the monthly cost of insulin at $35. If you switch to original Medicare, remember that you need to purchase a separate product Part D plan To cover prescribed medications, including insulin.
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