{"id":10232,"date":"2025-02-17T17:09:23","date_gmt":"2025-02-17T21:09:23","guid":{"rendered":"https:\/\/kerryhannon.com\/?p=10232"},"modified":"2025-02-17T17:35:07","modified_gmt":"2025-02-17T21:35:07","slug":"down-on-your-medicare-advantage-plan-nows-the-time-to-make-a-switch","status":"publish","type":"post","link":"https:\/\/kerryhannon.com\/?p=10232","title":{"rendered":"Frustrated with Your Medicare Advantage plan? Switch."},"content":{"rendered":"
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If you\u2019re steamed to discover your favorite doctor is no longer in your Medicare Advantage plan\u2019s network, now is the time to make a change.<\/span><\/div>\n<\/div>\n
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Medicare Advantage enrollees can switch plans or transfer to original Medicare during the open enrollment period ending March 31. You cannot, however, jump from a traditional Medicare plan to a Medicare Advantage one. You\u2019ll have to wait for the fall enrollment period for that move.<\/p>\n

Read on Yahoo Finance.<\/a><\/strong><\/p>\n

\u201cI call this the ‘buyer’s remorse’ enrollment period,\u201d Philip Moeller, a Medicare expert and the author of \u201cGet What\u2019s Yours for Medicare<\/a>,\u201d told Yahoo Finance.<\/span><\/p>\n

\u201cReviewing Medicare Advantage coverage and possibly switching makes sense this year,\u201d he said. \u201cThere were many changes to 2025 plans, including to drug plans and reductions by some plans in their coverage of routine dental, hearing, and vision care.\u201d<\/span><\/p>\n

This can be alarming if you\u2019re not paying attention.<\/p>\n

Medicare Advantage plans are an alternative health insurance program to traditional Medicare for those 65 and older. They\u2019re run by private insurance companies such as UnitedHealthcare and Humana and have been soaring in popularity in recent years.<\/p>\n

Enrollment in 2025 is projected to be 35.7 million \u2014 more than half of all people enrolled in Medicare.<\/p>\n

A big draw of Medicare Advantage plans is that they include coverage for benefits not included in traditional Medicare, such as drug coverage (Part D), eyeglasses, dental coverage, and fitness classes. Plus, they often have very low or even no premium costs.<\/p>\n

That can be enticing. This year, original Medicare\u2019s monthly Part B premiums are $185, and the annual Part B deductible, which most people must pay before their Medicare coverage begins, is now $257.<\/p>\n

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Your provider is ‘out of network<\/strong><\/h2>\n

There are disadvantages. Unlike original Medicare, depending on the Advantage plan, you\u2019re limited to a specific network of doctors and other healthcare providers, and those networks are ever-changing.<\/p>\n

It\u2019s not unusual to be referred to a specialist who is not part of your Medicare Advantage plan network. In those cases, you need prior authorization to make an appointment, or simply be prepared to pony up and pay the bill out-of-pocket.<\/p>\n

Therein lies the No. 1 motivation for people to jump plans: to have access to the healthcare providers they currently use or plan to.<\/p>\n

\u201cA reason people should review their plan options is they might not have realized that one of their providers is now out of network, and they’ve lost access to (their) preferred doctor, or maybe they didn’t realize that a copay for a regularly scheduled visit increased for this year,\u201d Meredith Freed, a senior Medicare policy manager at KFF, told Yahoo Finance.<\/p>\n

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What\u2019s more: Hospitals and healthcare providers are\u00a0terminating agreements with Medicare Advantage insurers<\/a>, citing too many denials and delays in approving care.<\/p>\n

Last year, the Centers for Medicare & Medicaid Services (CMS) announced new rules that will require Medicare Advantage insurers to rule on prior authorization requests more quickly, but the change won\u2019t take effect\u00a0until 2026<\/a>.<\/p>\n

The rule also requires a specific reason for denying a prior authorization request, which will help with resubmission of the request or an appeal when needed.<\/p>\n

A new drug cost cap<\/strong><\/h2>\n

Advantage plans also make changes that affect drug coverage and costs, including changes to formularies and preferred pharmacies, Freed said.<\/p>\n

\u201cSo taking a look at drug coverage is one important thing that people may want to consider for this year and making sure that their prescription drug plan is the best value for them, depending on the drugs that they take,\u201d she said.<\/p>\n

Importantly, enrollees may also not be aware of changes that have gone into effect due to the Inflation Reduction Act and how that might affect their prescription drug costs, Freed added.<\/p>\n

The big one: People with Part D plans through traditional Medicare or Medicare Advantage won’t pay more than $2,000 a year in out-of-pocket costs for their prescription medications, or for co-pays or coinsurance for the prescription drugs their plan covers.<\/span><\/p>\n

It used to be that many Advantage plans had no deductible, Diane Omdahl, a Medicare expert and founder of\u00a065 Incorporated<\/a>, told Yahoo Finance. Not anymore.<\/p>\n

In 2025, Advantage plans with a deductible are charging four times more than in 2024 \u2014 $225 vs. $59 \u2014 according to KFF.<\/p>\n

Traditional Medicare obstacles<\/strong><\/h2>\n

For those considering shifting to traditional Medicare, that choice takes some legwork.<\/p>\n

\u201cRegular Medicare does not come with built-in caps on a variety of out-of-pocket costs, so you don’t want to be enrolled in it without supplemental protection,\u201d said Mark Miller, a retirement expert and author of \u201cRetirement Reboot.<\/a>\u201d<\/p>\n

For that you need a Medigap health insurance policy sold by private insurance companies that pays part or all of certain leftover costs. Medigap can cover outstanding deductibles, coinsurance, and co-payments and may also cover healthcare costs that Medicare does not cover at all like medical care received when traveling out of the US.<\/p>\n

\u201cIn most states, the guaranteed right to buy a Medigap is limited to the time when you first sign up for Medicare Part B,\u201d Miller said.<\/p>\n

That\u2019s because Medicare does not permit Medigap plans from rejecting you or charging a higher premium because of a pre-existing condition during that period. In most states, your premium, however, will vary depending on factors such as your age, gender, and where you live.<\/p>\n

The Medigap guarantee policy is also good if you joined an Advantage plan during your first year of Medicare but disenrolled within a year and switched to traditional Medicare. After that, though, Medigap plans in most states can flat-out reject you if you have a pre-existing condition, such as diabetes. The exceptions are New York, Connecticut, Maine, and Massachusetts.<\/p>\n

Have a question about retirement? Personal finances? Anything career-related? Click here to drop Kerry Hannon a note.<\/em><\/strong><\/a><\/p>\n

Where to get help<\/strong><\/h2>\n

If you\u2019re mulling moving back to traditional Medicare or changing Advantage plans, you might start by contacting your State Health Insurance Assistance Program network (SHIP)<\/a>, which provides free one-on-one counseling in every state. You can find your local SHIP\u00a0here<\/a>.<\/p>\n

The\u00a0Medicare Rights Center\u00a0<\/a>offers a free consumer helpline: 800-333-4114. You can also contact Medicare directly at 800-633-4227.<\/p>\n

You can research your options via the\u00a0Medicare Plan Finder<\/a>. Enter the drugs you take and it will show you if they\u2019re covered by the Advantage plan. When you look at the various plans available where you live, you’ll see annual estimates of the cost of that plan based on the drugs you’ve entered into the tool.<\/p>\n

If you have a limited income, you might be eligible for Medicare\u2019s\u00a0Extra Help<\/a>, which covers Part D premiums and deductibles and caps drug costs.<\/p>\n

Keep in mind, too, that there could be alternatives for the drugs you’re taking, so it’s always good to ask your physician if there\u2019s one covered by your plan.<\/p>\n

Medicare Star Ratings can help you see how different plans compare. Star ratings, which focus on health plan quality based on measurements of customer satisfaction and the quality of care a plan delivers can be found using Medicare\u2019s Plan Finder tool.<\/p>\n

If you do decide to make changes to your coverage during this time, they would take effect the first of the month after you make the change.<\/p>\n

\u201cThe Medicare Advantage open enrollment period offers you an opportunity to switch to a different plan if you’re not happy with the one you’re in, but be sure to do your homework before leaping,\u201d Miller said.<\/p>\n