Table of Contents:

  1. Your Plan’s Terms of Service Have Changed
  2. A New Plan Better Suits Your Needs
  3. Your Health, ZIP Code, or Budget Has Changed

The Medicare Advantage Open Enrollment Period (MAOEP) is the annual window of time during which Medicare Advantage (MA) policyholders can switch MA plans or drop their coverage altogether and revert to Original Medicare. Occurring from January 1st to March 31st, the MAOEP is for current MA policyholders only. If you are currently enrolled in Original Medicare and are considering transitioning to MA coverage, you must enroll during the Annual Enrollment Period (AEP). This period occurs from October 15th to December 7th each year.

There are multiple reasons you might want to switch MA plans.

Your Plan’s Terms of Service Have Changed

Your Annual Notice of Change (ANOC) arrives in September every year. The ANOC, which is sent by your plan provider, alerts you to any changes that are being made to your plan’s terms. There are three aspects of your plan’s terms of service that are liable to change each year: coverage, costs, and provider networks.

Coverage refers to the services for which your plan provider will offer financial support. If you have an MA plan, this could include various forms of care (such as dental, vision, and hearing services), products (such as prescription drugs or medical equipment), and other specialty benefits (such as reimbursement for gym memberships). If, for instance, you selected your plan because a drug you require is in the plan’s formulary, but you see in your ANOC that the drug is no longer listed, you may consider finding a new plan during the OEP.

Costs consist of the four primary methods of payment you make for the coverage you receive. These four methods are: your monthly premium, deductible, copayment, and coinsurance. Your monthly premium is the set amount of money you pay for your plan each month, regardless of the services you use. The average premium for MA plans in 2021 is $21/month. Your plan’s deductible is the amount of money you have to pay toward a service before the plan’s coverage kicks in. This amount varies from plan to plan. Copayment refers to the set amount of money you must pay for a given service provided to you. Coinsurance refers to the percentage of cost for which you are responsible for a given service. Coinsurance and copayment generally must be paid for each service provided, unless you find a plan that requires no coinsurance or copayment once you have reached your deductible.

A plan’s network is the geographic region in which healthcare services will be covered and the healthcare providers included within the region who accept the plan. If your plan’s network changes and the area that you live in is no longer covered, you will have to find a new plan.

A New Plan Better Suits Your Needs

Each year, more and more new MA plans become available. Even if your current plan’s costs and coverage have remained the same, it is advisable to do some research during the fall when new plans for the upcoming year are announced. There is always the chance that a new plan will suit you better than your current coverage or other options you’ve reviewed in the past. Even if the new plan does not provide expanded coverage, it is possible that it could provide the same level of coverage as your current plan, but at a lower cost.

In some cases, new legislation can introduce plans that better suit your needs. One such example is the new Senior Savings Model, which is effective as of January 1st, 2021. As a result, beneficiaries can receive a 30-day supply of insulin for $35. This means the yearly cap on insulin is just over $420, which is a 66% decrease compared to the average price in 2020. According to the CMS, 1,635 plans, covering all 50 states, will offer this price cap. These plans will save daily users of insulin an average of $446/year. Not all MA plans adhere to the Senior Savings Model, so if you are a daily user of insulin, finding a plan that does offer this price cap on insulin may be a good enough reason to switch plans.

Your Health, ZIP Code, or Budget Has Changed

If your medical needs have changed since you selected your current MA plan, it is entirely possible that another more suitable plan is available that could save you money or better suit you. Because different MA plans cover different services, you may be able to find a plan that covers your recently developed medical needs. If, for instance, you require a new medication that has a hefty copayment, you can look for another plan whose formulary (the list of drugs covered by that plan) includes the prescription.

Additionally, changes to your living situation are another reason to take advantage of the MAOEP. For instance, if you are planning to move out of your plan’s current network, you will have to find a new plan that covers your new address. Alternatively, if you recently experienced a change in the composition of your household (a marriage, a death, etc.), you may require different coverage.

Information adapted from the Centers for Medicare and Medicaid Services