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Health Reform 101

with Lisa Zamosky

WebMD helps readers understand their health insurance and the new health care reform law. The Affordable Care Act is bringing sweeping changes to American health care. Lisa Zamosky is here to help you navigate the health care maze and understand how these changes affect you.

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Thursday, January 3, 2013

Not Happy with Your Medicare Advantage Plan? Change it!

By Lisa Zamosky

Medicare Card

We don’t get many opportunities in life for a “do-over” – the chance to make a different choice when our first decision was a mistake. But if you’re a Medicare beneficiary, January marks the start of a period when you can make changes to your Medicare coverage if you’re unhappy with your current plan.

Just one month after the end of the Medicare enrollment period, yesterday was the beginning of the Medicare Advantage Disenrollment Period (MADP), which runs from January 1 through February 14.

During these 45 days, you have the option of dropping your Medicare Advantage plan and returning to Original Medicare. You can also sign up for a Part D prescription drug plan to help cover the cost of your medications.

Think Before You Leap

One important consideration before leaving a Medicare Advantage plan for Original Medicare is that you cannot sign on to a Medigap plan during MADP. Medigap plans are administered by private insurers and are designed to help cover out-of-pocket costs not paid for by Medicare.

You’re only guaranteed a Medigap plan within the first six months of turning 65. After that, insurers can take the state of your health into consideration when deciding whether or not to sell you a plan. As a result, you can be denied, so you need to very carefully consider the potential financial implications of returning to Original Medicare without gap coverage.

There are other items to consider as well. Whenever you make a change to your health benefits, you need to make sure your doctor accepts the coverage and that your new drug plan covers the prescription medications you need.

It’s also critical that you understand how the new plan operates. Do you need prior authorization in order for the cost of your medication to be covered? Does the pharmacy closest to your home participate with your plan? Are there quantity limits placed on medications? These are the kinds of questions you need to ask to make sure you’re switching to a plan that will best meet your needs.

Get Help

Don’t be shy about asking for help to best understand your options. Having the right health benefits in place is so important for both your health and your finances, and there are experts available to assist you.

For free, unbiased assistance, contact your State Health Insurance Counseling and Assistance Programs (SHIP). You can find your local program by visiting the Medicare Helpful Contacts page at Medicare.gov or by calling (800) MEDICARE.

Another good resource is The Medicare Rights Center, which offers counseling and advocacy services.

Have you switched Medicare plans during the Medicare Advantage Disenrollment Period in the past? Why did you switch? Please share your experience in the comments section below.

Photo: Ingram Publishing

Posted by: Lisa Zamosky at 9:00 am

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