So, You Hate Your Medicare Advantage Plan: Now What?

Let’s face it: Not every Medicare Advantage plan is going to be the Cinderella-slipper perfect fit for your health care needs. Sometimes you’re going to feel more like one of the stepsisters, trying to squeeze into a plan and make it work.  

But here’s the thing: you don’t have to endure the long-term discomfort of a plan that’s not working for you. Today, we’re going to explore your options if your Medicare Advantage plan isn’t what you hoped.

Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Does your Medicare Advantage plan work for you?

There are no absolute guidelines to finding out if your current Medicare Advantage plan is meeting your needs. Everyone has unique circumstances and concerns to address.  

So, instead of generalizing your dislike of a plan, try to find the cause of the discomfort.

If you find yourself having negative answers to these questions, then it might be time to explore other plan options:

• Does your plan cover your doctors or are you having issues visiting the physicians of your choice?
• Are all your prescriptions covered and at affordable costs?
• Can you use your preferred pharmacy?
• Is it difficult to find a provider in your network?
• How much are your premiums?
• Have your coverage needs changed since you enrolled in your current plan?
• Did something change in your coverage that you are unhappy about?

Fun fact: We’ve got an entire post on plan changes and how they’re announced via the Annual Notice of Change every fall. Check out the post here.

Can I change my Medicare Advantage plan if I don’t like it?

If your current Medicare Advantage plan is not working for you, you have options and may be able to change your plan depending on the time of year. There are only a few times a year when you can change your Medicare plan.

The Medicare Advantage Open Enrollment Period (MA OEP) is from January 1 to March 31 every year and is designed for people who are dissatisfied with their current MA coverage.

During the MA OEP, you can change to another Medicare Advantage plan or switch back to Original Medicare. For more about Medicare Advantage Open Enrollment Period, we’ve got you covered with a previous blog all about it!  

Another option is to utilize the 5-Star Special Enrollment Period (SEP). From December 8th to November 30th, you have the option to switch to a 5-Star Medicare Advantage plan. You can only make this switch one time during your SEP.

Please reach out to our office if you're interested in the 5-Star SEP. You first need access to a 5-Star plan in your county. Some counties do not have any 5-Star plans. You also want to make sure the plan coverage and network is a good fit before making any changes – even if you hate your current plan.

Can I switch to another Medicare Advantage plan?

Switching Medicare Advantage plans can only be done at certain times, called Enrollment Periods. There are several Enrollment Periods:

• Initial Enrollment Period: this is when you can join a plan upon becoming eligible for Medicare.
• Open Enrollment Period: from October 15 to December 7 each year. ‍
• Medicare Advantage Open Enrollment Period: from January 1 to March 31 each year.  
• 5-Star Special Enrollment Period (SEP): from December 8 to November 30.

Can I drop my Medicare Advantage plan and go back to Original Medicare?

Yes, it is possible to switch back to Original Medicare if you are unhappy with your Medicare Advantage plan. However, it must be done during one of the Enrollment Periods listed above. Call our office for more assistance!

Can you cancel a Medicare Advantage plan at any time?

If this is your first year in a Medicare Advantage plan, you can cancel your MA plan at any time during the first year. However, you will need to either prove you have alternative coverage or return to Original Medicare to do so.

After your first year in Medicare Advantage, you will need to wait for the next Enrollment Period to make plan changes.

Conclusion

If you hate your Medicare Advantage plan, you have options. You do not have to be stuck with insufficient coverage for your needs.

Whether it be changing your MA plan or returning to Original Medicare, options are available to help you find your perfect fit. Give us a call and schedule an appointment to get personalized Medicare help.