Top 10 Things to Consider Before Switching Medicare Advantage Plans During Medicare OEP

Almost 40 percent of seniors are on Medicare Advantage (MA) Plans; some stay on the same plan for years while others may need to switch plans as their needs or the plan changes. With over 3,000 MA Plans available to choose from in 2021, the perfect plan should be out there.


Ideally, seniors choose the right Medicare Plan during the fall Annual Enrollment Period. Sometimes, though, people realize after the enrollment period has ended that the plan they signed up for isn’t quite right for their needs. The most common reasons for wanting to make a change is when a plan member discovers that one of their regular doctors is not in the plan’s network or one of their medications is not covered on the plan’s drug formulary. If needed, seniors on Medicare Advantage can move back to Original Medicare or switch to a different Medicare Advantage Plan during the Medicare OEP between January 1 and March 31.

If you are looking into changing your MA Plan, there are some things you should consider before making a final decision. We discuss the most important things to consider in this article but don’t forget that your Medicare Agent is always available to answer any questions you may have.


Top 10 Things to consider before switching Medicare Advantage Plans During Medicare OEP


1. You can only make one switch during the Medicare Advantage Open Enrollment period.


2. Once you finalize your change, you are locked into that plan for the rest of the year unless you qualify for a special election period.


3. Make sure the plan includes prescription drug coverage unless you have another type of creditable drug coverage.


4. Do the MA Plans you are considering come with a monthly premium and if they do, are they in your budget?


5. What out-of-pocket costs will you be responsible for? (In general, the lower the premium, the higher your out-of-pocket expenses - such as copays- will be).


6. Medicare Advantage Plans come with annual out-of-pocket maximums but there is a range of maximums so you will want to ask what it is for each plan you’re considering.


7. Does the plan’s network cover all your regular doctors?


8. Does the plan’s network cover other coverage you need such as diabetes-management suppliers and home health companies?


9. Does the plans’ drug formulary include your medications?


10. Is the plan a PPO or an HMO? This is important because HMO plans only provide


coverage for in-network providers and they also may come with more requirements like the need to get a referral to see a specialist. On the other hand, the are often less expensive than PPO plans.


The bottom line is that we all have specific health care needs, so it’s extremely important to consider what your needs are when choosing a Medicare Advantage Plan.


Contact a PBC Agent for Help


Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.


At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.

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