Knowing When to Change a Medicare Advantage Plan

October 23, 2020 | by Corina Savela

If you hire a patient advocate they will want to know what insurance you have and help you take advantage of all the features available that might help you in your situation or help you find insurance that is a better fit. Reasons to change your Medicare Advantage plan or at least consider it.

1. Change to a Medicare Advantage 5-star plan – you can change once per year – anytime in a Special Enrollment Period (SEP), not all areas have 5-star plans, if your area does, it is worth looking at, you can change to a 5-start plan any time of the year.

Be sure to review the plan costs as compared to your needs and your current plan, costs could be different, provider networks could be different and the PDP formulary also needs to be reviewed.

2. During AEP you should perform an annual review of your Medicare insurance situation. That should include evaluating different aspects of your situation:

How you are struggling to manage your current plan’s out of pocket costs (OOP)

Your prescription drug needs have changed

Your current plan's PDP benefits, pharmacy, etc have changed

Your medical condition(s) change, you might need a PPO not an HMO due to a complex medical condition

Your financial situation has changed (you might qualify for LIS, you might need to switch your type of coverage)

You want to drive less, or have moved and need a robust provider network closer to home, or in-home providers

Lifestyle changes, you were a snowbird or now are a snowbird and need coverage to match

3. Medicaid benefits (gain or loss)

You have a Special Enrollment Period (SEP) .

When you lose benefits, you should make a timely change, or you must wait for AEP in the fall and until then you will be responsible for the copays and coinsurance of your current plan.

When you gain benefits, you can change to take advantage of plans that could benefit you (you can change once per quarter Jan — Sep).

4. VA benefits (gain or loss)

Consider how the VA can work in conjunction with Medicare when you gain this benefit.

You could move to an area or live part-time in an area that does not have easy access to the VA, you will want to be sure you understand what Medicare coverage you have and how it works so you know how to use it when not near the VA.