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How to Switch Medicare Advantage Plans: A Step-by-Step Guide

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Whether you’re looking for better coverage, more affordable premiums, or just a plan that better suits your needs, you need to be aware of the process to switch your Medicare Advantage Plan. You should be aware that each year, plans can change their benefits, premiums, and networks, so you should review your plan annually to ensure it continues to meet your needs.

Steps to Switch Medicare Advantage Plans

1. Evaluate Your Current Plan

Start by assessing your current Medicare Advantage plan:

  • Does your plan cover the services you need? 
  • Are there gaps in your current coverage?
  • Are premiums, co-pays, and out-of-pocket expenses affordable? 
  • Have your financial or medical needs changed?
  • Are your preferred doctors, hospitals, and pharmacies in-network?
  • How responsive and helpful is your current plan’s customer service?
  • Have there been any changes to your current plan?

2. Research and Compare New Plans

Once you know what you need, research other Medicare Advantage plans available in Texas. The Medicare Plan Finder tool can help, or you can talk to a Medicare agent, like the ones at Wise Insurance, for guidance.

Look for additional benefits that are important to you, whether it’s dental, vision, or hearing coverage. Ensure your medications are covered and your preferred pharmacies are in-network, to avoid disruptions in your treatment. Make sure you also understand any associated costs.

In addition to benefits, you need to compare your prescription drug costs and make sure they are located in the plans formulary (aka list of drugs). You also want to make sure all your doctors will accept your new plan option. This is why working with an agent is important as we can do the research dn make sure you are gaining benefits and access by switching plans.

Check star ratings for plans based on quality and performance, for another perspective. Star Ratings can give you a better understanding of how the plan functions not just from a customer service perspective but also how well you can access your benefits with your providers. 

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3. Confirm Enrollment Period

Ensure you are within an eligible enrollment period to switch plans, or check if you qualify for a Special Enrollment Period.

Enrollment Periods to Switch Plans

Enrolling early within the designated enrollment period helps ensure that your new coverage begins on time and that there is no interruption in your healthcare services. 

Mark your calendar to keep track of key dates to help you. Missing the designated enrollment periods can leave you stuck in your current plan for another year unless you qualify for a Special Enrollment Period.

Failing to time your switch correctly could result in a period of no coverage, leaving you responsible for the full cost of any medical services or prescriptions during this time. Ensure: 

  • Your new plan enrollment is confirmed
  • You have a start date
  • The plan starts immediately after your old plan ends to avoid any lapse in coverage
Annual Enrollment Period (AEP)

This runs from October 15 to December 7 each year. You can switch from one Medicare Advantage plan to another, join a Medicare Advantage plan, or return to Original Medicare.

Medicare Advantage Open Enrollment Period (OEP)

From January 1 to March 31, beneficiaries already enrolled in a Medicare Advantage plan can switch to another Medicare Advantage plan or return to Original Medicare. However, you cannot switch from Original Medicare to a Medicare Advantage plan.

Special Enrollment Periods (SEPs)

You may be able to make changes at other times if you experienced certain life events, such as moving out of your plan’s service area,  or losing other insurance coverage.

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4. Enroll in Your New Plan

To switch to a new Medicare Advantage plan, you can enroll online directly. You’ll need your Medicare Number and the start dates for your Part A and Part B coverage, as well as other information.

5. Notify Your Healthcare Providers

Once you’ve enrolled in a new plan, inform your doctors and other healthcare providers. Provide your new insurance information to all your doctors, specialists, and pharmacies as soon as your new plan takes effect. This ensures they have updated information, can verify they are in-network, and can correctly bill your new plan to avoid potential issues with claims or referrals.

6. Disenroll from Your Old Plan

When you enroll in a new Medicare Advantage plan, you will be automatically disenrolled from your previous plan. There is no need to take further action, unless you are on a Medicare Supplement plan. When doing your enrollment, we can help you understand any other actions required for disenrollment if needed. 

7. Understand Your New Plan’s Terms

After switching, carefully review your new plan’s terms and conditions, even though you evaluated and investigated the plan before switching. 

Confirm…

  • Your new coverage start date
  • Specific benefits and cost-sharing details
  • Your doctors and preferred facilities are in-network and accessible to you
  • Verify your prescriptions are covered and the out of pocket costs

Each Medicare Advantage plan has its own set of benefits, rules, and cost structures. Understanding these will help you make the most of your new coverage and avoid unexpected costs. 

Documentation and Record Keeping

Keeping detailed records of all your interactions and confirmations, including physical or digital copies of enrollment forms, confirmation numbers, and any correspondence with your new and old plan providers, is recommended. For phone calls, note the date, time, the representative’s name, and the details of the conversation.

Get Help

If you have questions or issues, don’t delay getting help; this prevents complications later. The friendly team at Wise Insurance is here to help you, at any stage of your Medicare journey.

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