How to Switch to a New Medicare Plan During Open Enrollment
Fall Open Enrollment Period for Medicare kicks off October 15th. This is the time of year when current Medicare enrollees can select or change Medicare benefits.
If you’re on a Medicare plan, evaluate your current plan to make sure the coverage and costs fit your needs. To help you, your Medicare plan will mail you your Annual Notice of Change letter in late-September or early October detailing the upcoming changes to your current plan. Meanwhile, the Center for Medicare and Medicaid will also mail your Evidence of Coverage document during the same time frame, enabling you to compare the benefits.
If you’re content with your choices, simply reenroll with your current selections. However, if you’re not satisfied and wish to make changes, now’s the time to do it. And while it can be a challenge, understanding how it works will help make your transitions as pain free as possible. Here’s what you need to know.
Types of Changes To Medicare that Can Be Made
You can swap Medicare Parts A and B for C and vice versa. Add or drop Parts B and D. And change Part C carriers. Yes, it sounds like alphabet soup. If you’re a little rusty on Medicare terminology, here’s a brief rundown:
Medicare Part A is known as original Medicare and covers inpatient hospital care, inpatient care at skilled nursing facilities, hospice and home health services; it’s administered by the federal government.
Medicare Part B is also known as original Medicare and covers doctor visits, lab services, outpatient and preventive care, home health care, screenings, surgical fees and supplies, physical and occupational therapy; it’s administered by the federal government.
Medicare Part C is commonly referred to as Medicare Advantage or MA Plans, is a combination of parts A and B and may include D; it’s administered by private insurances companies.
Medicare Part D is often called prescription drug coverage and helps cover and lower costs of prescription medications and may be used as a stand-alone plan or in conjunction with parts A, B or C; it’s administered by private insurance companies.
Medicare supplement insurance is commonly referred to as Medigap and covers some of the uncovered costs associated with parts A and B, such as copayments, coinsurance and deductibles; it’s administered by private insurance companies.
Medicare Annual Election Plan (AEP) is the eight-week period, spanning from October 15 to December 7 each year, in which you can sign up for, change or disenroll from a Medicare benefit.
Initial Enrollment Period (IEP) is the period in which you can enroll for Medicare benefits. It runs three months before you turn 65 and three months after it.
General Enrollment Period (GEP) is the period in which you can enroll in Medicare benefits if you missed your IEP. It runs from January 1 to March 31 each year.
Special Enrollment Period (SEP) is a period that allows enrollment based on extenuating circumstances such as moving out of your plan’s service area, moving into an institution/nursing facility or if your plan ends its contract with Medicare, or your plan no longer offers creditable drug coverage.
How to Make Coverage Changes
Enrolling in Part A
If you’re like most Medicare recipients, you probably enrolled in Part A when you were first eligible for Medicare benefits. If you’ve since switched to Part C but prefer Part A benefits, you can reenroll during AEP or SEP online by visiting www.socialsecurity.gov and following the instructions. Or you can call Medicare toll-free at 1-800-MEDICARE (or 1-800-633-4227), or 877-486-2048 if you use TTY, and speak to a Medicare representative. You can also simply visit your local Social Security office.
Disenrolling in Part A
If you would like to disenroll in a Part A to enroll in a Part C plan, call your local Social Security office or the Social Security Administration at 1-800-772-1213, Monday through Friday between 7 a.m. and 7 p.m. ET.
Enrolling in Part B
If you opted out of Part B during your IEP and would like to add it, you can add it during the GEP. Enrollments during this period become effective July 1. But there may be financial penalties for enrolling in Part B during GEP instead of IEP. For instance, you may have to pay a late fee or a higher premium. However, penalties are waived if you’re enrolled in Medicare but had coverage either through an employer or your spouse. To add Medicare Part B, call the Social Security Administration at 1-800-772-1213, Monday through Friday between 7 a.m. and 7 p.m. ET.
Disenrolling in Part B
You may not need Part B if you still have coverage through a job or your spouse. If you already opted in, dropping it will save you the monthly premium. Before you do, make sure the coverage from your employer is your primary coverage and your Medicare coverage is secondary.
To disenroll, call your local Social Security office or the Social Security Administration at 1-800-772-1213. They’ll interview you to make sure you understand the possible financial penalties for reenrolling in the program and guide you on completing the CMS-1763 form.
If you change your mind and decide you want Part B after all, the late penalty should not apply to you as long as you sign up while you or your spouse is still receiving benefits. This falls under the SEP and is available up to eight months after you or your spouse retire or stop working.
Enrolling in Part C
Medicare Part C plans offer the same benefits as combined Medicare A and B (except for hospice care), but may have lower monthly premiums, copayments and coinsurance. To be eligible, you must have Parts A and B and reside in the servicing area of the Part C plan you’re considering.
Because plans are offered through a commercial carrier, many of the same plan options are available:
- HMO (Health Maintenance Organization): sets up a network of providers for you to receive your care, driving down premiums and copayment costs.
- PPO (Preferred Provider Organization): sets up a network for providers for you to receive your care but covers both in- and out-of-network providers, enabling you to choose any provider that accepts Medicare.
- PFFS (Private Fee-for-Service): predetermines reimbursement for providers and how much the patient will pay for services. Doctors must agree to the payment terms and to treat you.
- SNP (Special Needs Plan): provides benefits for people with special needs such as living in an institution, living with a chronic condition like HIV/AIDS or End Stage Renal Disease (ESRD) or being dual enrolled in Medicaid and Medicare.
- HMO-POS (Health Maintenance Organization – Point of Service): covers both in and out-of-network services, but at different rates.
- MSA (Medical Savings Account) – combines a high deductible insurance plan with a savings account to help you meet the deductible.
If you’re interested in a Part C plan, shop around for a carrier and a plan that suits your needs. A licensed health insurance broker/agent may be able to help you. You can enroll during AEP or SEP by completing forms found on the carrier’s website, calling the carrier directly or submitting paperwork to them.
Disenrolling in Part C
If you prefer Part A and B benefits, you’ll need to disenroll from Part C. You can transition back to A and B during AEP or SEP, as well as the Medicare Advantage Disenrollment period, which spans January 1 through February 14 each year. Contact the insurance carrier to disenroll.
Enrolling in Part D
Part D coverage is voluntary, but with the rising costs of prescription medications, enrolling may be a good idea. To be eligible, you need to be enrolled in Medicare Parts A, B and/or C and reside in the servicing area of a Part D plan.
If you have Part A coverage, you can add a stand-alone plan to your Medicare Cost plan, Medical Savings Account (MSA) plan or Medicare Private Fee-for-Service (PFFS) plan. And if have Part C, a prescription drug plan may already be included. Bear in mind, you can’t enroll in two prescription plans; in other words, you can’t join a stand-alone plan if you’re enrolled in Part C plan with drug coverage.
You can enroll in a Part D plan during your IEP, AEP, Medicare Advantage Disenrollment Period or SEP. To enroll, you can call Medicare at 1-800-MEDICARE (or 1-800-633-4227). If you use TTY, call 877-486-2048 toll free. You can also visit www.medicare.gov, use the plan finder program to compare plans and click the enroll button to select your plan.
Disenrolling in Part D
The only time you can disenroll from your Part D plan is during AEP or under conditions defined by a SEP. To disenroll from a Medicare Part D plan, call Medicare toll-free at 1-800-MEDICARE (or 1-800-633-4227), or 877-486-2048 if you use TYY, and ask to speak to a Medicare representative. Have your Medicare Claim Number ready for the representative. You can find it on your red, white and blue Medicare ID card. To disenroll from a drug plan associated with Part C, you can call the carrier, using the number on the back of your card. Although a representative may be able to handle your request over the phone, he/she will probably suggest you send a registered letter.
Switching Medicare plans can be confusing and time consuming. Calling Medicare or visiting their website can provide you with information on enrollment periods and specifics on Parts A, B and D. And if you have Part C with a drug plan, your insurance company and/or agent can be of assistance.
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