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When it comes to Medicare Advantage plans, they shouldn’t be as permanent an option as you might think.
Your 2021 plan, which you have chosen or re-enrolled in, can be changed or abandoned between January 1st and March 31st. That is, you can change the Advantage plan for another or let it go back and back to basic Medicare (Part A hospital and Part B outpatient coverage).
Danielle Roberts, co-founder of insurance company Boomer Benefits, said the most common reasons beneficiaries make changes are that doctors are not on the plan’s network or that no drugs are included in their coverage. .
Also from January 1 through March 31: If you missed the initial Medicare enrollment period and are not eligible for an exception, you can enroll during that time. If that’s your situation, coverage won’t begin until July 1, said Elizabeth Gavino, founder of Lewin & Gavino and independent broker and general agent for Medicare plans.
Of the approximately 63 million Medicare beneficiaries, about 25 million are enrolled in a benefit plan, which provides parts A and B and typically Part D prescription drug coverage, along with extras such as dental and vision.
The current opportunity to change or withdraw your Advantage plan comes a few weeks after your annual Medicare enrollment closes in the fall, when several options were available for those who wanted to change their coverage.
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Instead, the next window related to the Advantage plan includes restrictions.
For starters, you can only make one change. This means that once you switch to a different benefit plan or leave it for basic Medicare, the change is usually blocked for 2021 (unless you have an exclusion that allows you to get a special enrollment period).
In addition, this three-month window does not allow you to switch from one Part D prescription drug to another.
If you chose a Part D plan during the fall-open enrollment period based on faulty or misleading information, you can call 1-800-Medicare at any time of the year to see if your situation suits you. will allow you to make a change.
Meanwhile, withdrawing a benefit plan in favor of basic Medicare often means losing drug coverage, which means you should enroll in a stand-alone Part D plan. This matters, because if you go 63 days without coverage, you could face a late lifetime enrollment penalty that will affect your monthly premiums.
Also, if you go back to original Medicare and want to get an additional policy (also known as “Medigap”), keep in mind that you may not meet the requirements for guaranteed coverage. These policies cover all or part of the cost sharing of some aspects of Parts A and B, including deductibles, copayments, and coinsurance. Still, they come with their own rules for signing up.
“If someone plans to go back to original Medicare and get a Medigap plan, they should be aware that they will probably have to answer health questions and go through subscription,” Roberts said.
It is advisable to start the process by applying for the Medigap plan and obtaining approval before leaving the Advantage plan or enrolling in a stand-alone Part D plan.
“Enrollment in the Part D plan will take them out of the Medicare Advantage plan, so it’s important to wait for that part as well,” Roberts said. “We encourage people who need to make a change to do so at the beginning of the election period.”