Personal Finance

If you don't like your Medicare Advantage plan, here are your options

Key Points
  • Of Medicare's 62 million or so beneficiaries, roughly 38% (23 million) choose to get their coverage through an Advantage Plan.
  • During a three-month window that started Jan. 1, beneficiaries can change their coverage either by switching to another Advantage Plan or dropping it.

If you're a Medicare beneficiary enrolled in an Advantage Plan and you don't like your 2020 coverage, you get a do-over of sorts.

Although your choice for 2020 was generally locked in by the end of 2019, the Medicare program provides a three-month window from Jan. 1 through March 31 when you can swap your Advantage Plan for another, or drop it and return to basic Medicare (Part A hospital coverage and Part B outpatient coverage). Before you switch your coverage, though, be sure you're aware of potential snags involved in the move.

In other words, do your due diligence, said Danielle Roberts, co-founder of insurance firm Boomer Benefits in Fort Worth, Texas. "If you make another mistake in your choice, you'll be stuck with it for the rest of the year," she said.

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Of Medicare's 62 million or so beneficiaries, more than a third choose to go with an Advantage Plan, which delivers Parts A and B and usually Part D prescription drug coverage, along with extras such as basic dental and vision. While most recipients tend not to change their plan from year to year, experts generally agree that evaluating whether there's a more cost-effective option should be a annual event.

The current three-month opportunity to change or drop your Advantage Plan started just a few weeks after the close of Medicare's annual fall open 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 or drop it for basic Medicare, the change is truly locked in for the rest 2020 (unless you meet an exclusion that qualifies you for a special enrollment period).

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Additionally, this three-month window does not allow you to switch from one stand-alone Part D prescription drug plan to another.

If you picked a Part D plan in the fall open enrollment period based on faulty or misleading information, you can call 1-800-Medicare at any point during the year to see if your situation would allow you to make a change.

Meanwhile, if you were to drop an Advantage Plan in favor of basic Medicare, it typically means losing prescription drug coverage, as well. That would mean you need to enroll in a stand-alone Part D plan. This matters, because if you go 63 days without acceptable drug coverage, you could face a lifelong penalty that is in addition to your premiums.

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Also, if you switch back to original Medicare and want to get a supplemental policy (also called Medigap), you may not get guaranteed coverage, depending on various factors that include where you live and exactly how long you've had your Advantage Plan. These policies either fully or partially cover cost-sharing of some aspects of parts A and B, including deductibles, copays and coinsurance.

"You might have to go through medical underwriting and answer health questions from the insurer, and you might not get coverage," said Elizabeth Gavino, founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans.

If you'll be subject to a health check, be sure to apply for the supplement before you drop your Advantage Plan.

"The worst-case scenario is that you go back to original Medicare and then no company takes you for Medigap, and you're stuck for the rest of the year," said Roberts at Boomer Benefits. "So the order of events is really important."

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

The average Medicare beneficiary has 28 plans available to them this year, up from 24 in 2019, according to the Kaiser Family Foundation. However, 77 U.S. counties — generally in rural areas — have no Advantage Plan available.

If you want to switch to a different Advantage Plan, remember to make sure your doctors and other providers are in-network, Roberts said. And, assuming the plan includes Part D prescription drug coverage (most do), be sure that any medications you take are covered.

Separately, also possible through March 31: If you missed your initial Medicare enrollment period and don't qualify for an exception, you can sign up now. If this is your situation, coverage won't start until July 1.

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