Reevaluating your Medicare plans

You should periodically be reevaluating your Medicare plans to ensure that you have the best plan for both your medical needs and your budget. It’s a good idea to do a review at some point during the summer months or the early Fall, since Medicare’s annual Open Enrollment period starts on October 15 each year. During Open Enrollment, you can freely add, remove, or change coverage plans without penalty. You can use the “three C’s” model for your yearly evaluation:

  • Coverage – Ask yourself if you have enough (or too much).
  • Convenient – Ask yourself if the coverage is convenient.
  • Cost – Ask yourself if the cost is appropriate and well within your means.

If you answer “no” to any of those questions, then it’s best to shop around for a better plan during Open Enrollment. During Open Enrollment, you may switch from Original Medicare Part A and B to a more robust Medicare Advantage plan, sometimes called Medicare Part C. You may also change from a Medicare Advantage plan back to Original Medicare Part A and Part B. You may also switch between different Medicare Advantage plans. Finally, during Open Enrollment you may join, leave, or switch between Medicare Part D prescription drug plans.

Changing plans

If you’ve signed up for Original Medicare, there are times you may want to drop the Part B coverage. One example is if you still have coverage from your job or from your spouse’s job. If you were automatically enrolled in Part A and Part B when you turned 65, then you must follow the instructions that came with your enrollment card and send it back. If you keep the card, you’ll keep Part B and will be billed for Part B’s monthly premiums. If you were not enrolled in Medicare automatically but instead signed up yourself through Social Security, you must contact the Social Security office if you wish to drop Part B coverage.

If you’re already enrolled in Original Medicare Part A and Part B but you want to sign up for Part C (Medicare Advantage), you may only do so during specific times. You may choose an Advantage plan during your seven month initial enrollment period that falls around your 65th birthday. The next option is to switch to an Advantage plan during Open Enrollment between October 15th and December 7th of every year. If you’re already enrolled in an Advantage plan but you want to switch to a different Advantage plan, you can only do so during this Open Enrollment. Contact both your current plan and the proposed new plan to start the process.

If you want to leave a Medicare Advantage plan and return to Original Medicare Part A and Part B, you may do so during the Open Enrollment. You may also do this during the Medicare Advantage Disenrollment Period from January 1st to February 14th of each year.

If you want to switch from a Medicare Advantage plan to a Medigap plan (also called Medicare Supplemental Insurance), you can only do so under a limited set of circumstances. If you joined an Advantage plan during your initial Medicare eligibility window but aren’t happy with the plan, you can return to Original Medicare within 12 months with no penalty. If you are moving to a new state that your Advantage plan does not service, you may return to Original Medicare and choose a supplemental Medigap plan.

If you want to switch your Part D prescription drug plan, you may do so during the October Open Enrollment. If you receive Extra Help benefits, you can switch plans once per month. You can also switch Part D plans if:

  • you move out of your current plan’s coverage area
  • you enter, leave, or live in a nursing home
  • your plan changes and no longer serves your area
  • you are part of the Extra Help program

You may not change your Part D plan simply because the plan’s drug list changes. Plans are required to provide 60 days notice prior to changing formularies.

Suspending Medigap coverage

If you want to switch Medigap plans, you may only do so without penalty if you’re within your six month Medigap Open Enrollment Period, or you have guaranteed issue rights. In some cases you can suspend your coverage. If you want to suspend your Medigap coverage because you have gotten a job, you may do so if you have Medicare and Medigap under age 65 and you go back to a job that offers health insurance. You may also suspend if you are the spouse, adult child, or dependent of someone who gets a job with health insurance.

Another situation that will allow you to suspend Medigap coverage is if you qualify for Medicaid. In this scenario, you can suspend coverage for up to two years. Your insurance company can tell you how to start this process. Keep in mind that if you already have Medicaid, you cannot purchase a Medigap policy unless Medicaid pays your Medigap premium or Medicaid pays all or part of your Medicare Part B premium.

Medigap plans are not compatible with Medicare Advantage (Part C) plans. This means that you cannot use your Medigap policy to pay for your Medicare Advantage co-payments, premiums, or deductible.

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