Albuquerque Journal

Are you in the wrong Medicare Advantage plan?

- By Kate Ashford NerdWallet

Many people choose Medicare Advantage plans without exploring their options or noticing what changes their plan may have made, according to research from KFF, a health policy nonprofit. But now that a new year has started, you may realize the plan you picked during Medicare’s fall open enrollment doesn’t work for you. Or maybe you stuck with your old plan and it changed this year.

Medicare Advantage open enrollment, which runs from Jan. 1 to March 31, gives members the option to switch Medicare Advantage plans or move back to Original Medicare.

Here’s where to start.

DOES YOUR CURRENT COVERAGE WORK FOR YOU?

Even if you haven’t stress tested your plan yet, do some research while there’s still time to change your mind. Are there providers or specialist­s you want to see or hospitals you prefer? Make sure they’re in your network.

Check your medication­s, particular­ly if you’re on a newer drug that may be covered differentl­y by different plans.

Then, think about your situation this year. “Are there any procedures, like a surgery that’s coming up?” says Christophe­r Fong, director and co-founder of Smile Insurance Group in Mesa, Arizona. The more you can predict your health care usage, the more accurately you can determine whether you’re in the right plan.

Next, consider your lifestyle. Do you travel or plan to spend part of the year in another state? Make sure your insurance offers an extended network or travel benefit. Or consider Original Medicare, which allows you to see any doctor in the country who accepts Medicare.

WHAT CAN YOU DO DURING MEDICARE ADVANTAGE OPEN ENROLLMENT?

During this time, people who are already enrolled in a Medicare Advantage plan can switch — once — to another Medicare Advantage plan, or they can return to Original Medicare and purchase a Medicare Part D prescripti­on drug plan. But if you don’t already have Medicare Advantage, you can’t join a plan now.

That said, although you can return to Original Medicare, you may not be able to sign up for Medicare Supplement Insurance, or Medigap. Medigap’s open enrollment period — when insurance companies must offer you a plan at the same price as everyone else, regardless of health issues — lasts for six months after you’re 65 and have Medicare Part B. After that, aside from a few states and situations, you’ll be subject to medical underwriti­ng to qualify.

SHOULD YOU SWITCH PLANS?

Some circumstan­ces are red flags — meaning you should probably change your coverage. If your primary care physician or primary hospital system is now out of network, for instance, you’ll want to look for a plan that includes them.

If an expensive medication isn’t covered, see if there’s a plan that includes it. (You can input your medication­s into the plan finder on Medicare.gov to see options.) Make sure when you’re estimating drug costs that you’re as accurate as possible about what you’re taking, including name and dosage. “Some people will get confused between the generic version and the brand name version, and there’s a huge difference,” says Emily Gang , CEO of the Medicare Coach, a site that provides Medicare guidance.

If you had a health event and found that you weren’t covered in the way that you expected, give switching plans some thought, but consider that any money you’ve paid is a sunk cost. And it may not make sense to start over in a new plan with a new deductible.

In general, resist switching plans for the perks alone. Then, next year, do your homework during Medicare’s fall open enrollment from Oct. 15 to Dec. 7.

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