Unhappy with your Medicare Advantage Plan? You Can Change Your Coverage Before 3/31

Unhappy with your Medicare Advantage Plan? You Can Change Your Coverage Before 3/31

If you or someone you know is not happy with their Medicare Advantage Plan, you can change your plan or return to Original Medicare and get a new Part D plan during the Medicare Advantage Open Enrollment Period (MA OEP). The MA OEP runs from January 1 through March 31 each year. This opportunity to change coverage is one of several that are important to remember, especially with all the inaccuracies reported on the new Medicare Plan Finder during last year’s Open Enrollment from beneficiaries, health plans, advocates and SHIP counselors throughout the country. Some of these reported inaccuracies include:

 

  • Data on the Medicare Plan Finder (MPF) not matching data on insurance company websites. In some cases, insurance companies advised members not to use the MPF for information, but to instead come to their website.
  • Drastically inflated costs for some drugs and incorrect premiums and costs for people with Part D’s low-income subsidy (Extra Help).
  • Incorrect premium costs for numerous MA and Part D plans.
  • Wrong information on drug formularies, and more. For more info on the problems, see our article, While Medicare’s Open Enrollment is Over, Consequences for the Medicare Plan Finder’s Inaccuracies Are Not.

 

While the Centers for Medicare and Medicaid Services (CMS) has continued to admit no fault or mistakes on the new MPF and only tout success, as seen in again in their recent January 10th blog, California Health Advocates and advocates around the country are keeping a close eye on CMS and giving significant pressure to make sure they grant any additional Special Enrollment Periods (SEPs) needed for people who made a plan choice that doesn’t meet their needs due to faulty information on the Plan Finder. Please report any such cases to us and/or your local Health Insurance Counseling and Advocacy Program (HICAP).

 

Other rights to change your coverage

In addition to the MA OEP and any SEPs granted by CMS for plan inaccuracies, there are two opportunities for eligible beneficiaries to disenroll from their MA plan and return to or buy a Medigap policy to supplement Original Medicare. These “opportunities” are two Medigap guaranteed issue rights known as Medicare Trial Period #1 and Medicare Trial Period #2.

 

  • Under Medicare Trial Period #1, you have the right to purchase certain Medigap plans if you joined an MA plan when you first became eligible for Medicare at age 65, and you want to switch to a Medigap policy during your first 12 months in your MA plan. Note: If you were previously in an MA plan, you are not eligible for this guaranteed-issue right. Also, this event only applies at age 65, and does not apply if you delay Part B and apply later.
  • Under Medicare Trial Period #2, you have the right to purchase certain Medigap plans if you switched from a Medigap policy to an MA plan for the first time since becoming eligible for Medicare, and you disenroll from that plan within the first 12 months. You have the option to return to your previous Medigap policy if it is still available. If it is not available, you can choose plans A, B, C, F, K, L, M or N from any company.Note: If you were previously in an MA plan, you are not eligible for this guaranteed-issue right.

 

There are also many Special Election Periods for Medicare Advantage and Part D prescription drug plans under certain circumstances. These SEPs allow you to enroll in or disenroll from a Medicare Advantage plan or Part D plan depending on your situation. You can find a list of these situations here.

 

In summary, if you are in a Medicare Advantage plan and are not happy with your coverage, there are several opportunities for you to make a change:

  • The Medicare Advantage Open Enrollment Period from January 1 to March 31
  • Various Special Election Periods to change your MA and/or Part D plan based on certain circumstances
  • Medicare Trail Periods #1 and 2 for eligible beneficiaries that give you a guaranteed issue right to disenroll and purchase a Medigap plan, and
  • A Special Enrollment Period from CMS for anyone who is in the wrong plan due to inaccurate information from the Medicare Plan Finder.

 

For more information and/or assistance in exercising any of these change in coverage opportunities, contact your local Health Insurance Counseling and Advocacy Program (HICAP).

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.