Should You Switch Your Medicare Advantage Plan?
Medicare’s open enrollment, happening now, is your annual opportunity to play the field. Here’s how to assess your options.
Medicare is not marriage: There’s no till-death-do-you-part provision. This is a good thing, because as the popularity of Medicare Advantage plans (Part C) continues to grow, you likely have an ever-growing array of options available to you.
More than 30 million Medicare beneficiaries are enrolled in Medicare Advantage plans, according to the Kaiser Family Foundation (KFF). Medicare Advantage Plans are offered by private insurance companies and allow you to receive your Original Medicare (Parts A and B) benefits through a plan with potentially more robust coverage. According to the KFF, the average Medicare beneficiary now has 43 plans to choose from.
Every year from October 15 to December 7, during Medicare’s annual open enrollment period, you can switch to or from Original Medicare or change Medicare Advantage plans. (There is also a Medicare Advantage open enrollment period — January 1 to March 31 — where those with an Advantage plan can switch to a different Advantage plan or return to Original Medicare.)
This is your chance to explore your options and potentially make a change.
Should you? Start by checking your Annual Notice of Change document from your current Medicare Advantage plan, which will let you know any upcoming changes to coverage or costs. Then ask yourself these four questions.
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Question #1: Are You Happy with Your Current Plan’s Network?
Your Medicare Advantage plan is probably an HMO, PPO, or another type of managed care plan that requires you to use a particular network of doctors, hospitals, and other health providers—or charges you more for using out-of-network providers.
It’s important to have a plan that lets you use local providers that you’re satisfied with. If you don’t go to a certain doctor because he or she doesn’t accept your health plan, it’s a red flag — you should use this time to shop around. Your insurer’s site will have a provider directory that allows you to search for doctors by name or zip code.
Question #2: Are You Getting a Good Value from the Premiums and Out-of-Pocket Costs You Pay?
The average monthly premium for a Medicare Advantage plan with prescription drug coverage in 2023 was $15, according to the KFF. But premiums vary widely. Some Medicare Advantage plans have no monthly premium but may have higher deductibles, coinsurance, or copayments.
Evaluate how many health care services you get in a typical year — or expect to need in the year ahead — and determine whether you’re better off with a lower-premium plan that has higher deductibles, coinsurance, and copays or a higher-premium plan with lower deductibles, coinsurance, and copays.
If you visit the doctor rarely or just occasionally, you may fare better financially with a low- or no-premium plan. On the other hand, if you use lots of health services, you may want a higher-premium plan with more expansive coverage.
Question #3: Is Your Medicare Advantage Plan Well Rated?
The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage plans on a one-to-five-star scale, based on several performance measures that gauge customer satisfaction, plan responsiveness, and quality of care.
You can find and compare Medicare Advantage plans by star rating, costs, and other factors with Medicare Plan Finder, a tool through the U.S. government’s official Medicare site.
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Question #4: What Extra Benefits Matter to You Most?
Medicare Advantage plans can offer an array of benefits that may be valuable to you. These may include vision and dental care, hearing devices, and the SilverSneakers fitness benefit.
Consider what extra benefits you currently use — or would like to have — and look for a plan with those benefits. SilverSneakers, for example, is included in many Medicare Advantage plans. It offers access to thousands of gyms and fitness classes nationwide at no extra cost to you. (If you choose to go with Original Medicare and a Medicare Supplement, or Medigap, plan, many Medicare Supplement insurance plans also include SilverSneakers.)
Looking for a plan that includes SilverSneakers? Click here.
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