Personal Finance

If you want switch to a different Medicare Advantage Plan, you get a 'do-over'

Key Points
  • The new opportunity to make changes runs from Jan. 1 to March 31.
  • If you move to another Advantage Plan, make sure it fits your needs. You can only make one change during this window.
  • As in past years, you also can drop your plan and return to original Medicare.

If that Medicare Advantage Plan you picked isn't working out, you'll be glad to know you get a do-over.

Effective this year, you get a chance between Jan. 1 and March 31 to swap it for another Advantage Plan.

"Maybe you discovered your doctor isn't in network, or your medications aren't covered, or you don't like the customer service," said Elizabeth Gavino, founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans. "If that's the case, there could be a better option."

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You also can drop your plan in favor of original Medicare, which consists of Part A (hospital coverage) and Part B (outpatient coverage). This option already was available in the past during a short early-year window.

Also possible until before March 31, but not new: If you missed your initial Medicare enrollment period and don't qualify for an exclusion, you can sign up now. In this case, coverage won't start until July 1.

Meanwhile, the current opportunity to change or drop your Advantage Plan comes just a few weeks after the close of Medicare's fall annual enrollment, when a variety of options were available for those who wanted to make changes to their coverage.

For this current period, however, there are restrictions.

For starters, you can only switch once. This means that once you move to a different Advantage Plan, it's locked in until the next fall enrollment (unless you meet an exclusion).

"There are no take-backs," Gavino said.

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Additionally, you cannot switch from one stand-alone Part D prescription drug plan to another or go from original Medicare to an Advantage Plan.

If you return to original Medicare and had Part D coverage through your Advantage Plan, you need to make sure you enroll in a stand-alone prescription drug plan. This matters, because if you go 63 days without the coverage, you may face a lifelong penalty that gets tacked on to your premiums.

Also, if you switch back to original Medicare and want to get a supplemental policy (also called Medigap), you might need to be approved by the insurer, depending on where you live and exactly how long you've had your plan.

If you want to switch to a different Advantage Plan, your options largely depend on where you live.

The more rural the area, the more likely you are to have fewer choices for an Advantage Plan. In fact, 115 counties dotting the country have none available to them for 2019, according to the Kaiser Family Foundation. That's down from 149 counties without one in 2018.

However, the average person on Medicare can choose from 24 plans. For prescription drug coverage, the average beneficiary can choose from 27 stand-alone plans or 21 Advantage Plans that include the coverage for 2019.

Because this enrollment window gives you one shot to make a change, make sure you know what you're signing up for.

"I had a client call and say he wanted to be on a plan that was recommended to him by people he knew, but I looked into the plan and found it didn't cover his medication," Gavino said.

In other words, make sure that any medicine you take is on the plan's approved list and that your doctor and pharmacy are in-network.

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