Re-Evaluating Coverage


Changing Medicare Plans

It’s a good idea to review your Medicare coverage yearly, with the following in mind:

  • Coverage
  • Convenience
  • Cost

Each year, during the Annual Open Enrollment period for Medicare Advantage and Prescription Drug Plans, you have the option to change plans. Your options are:

  • Changing from Medicare Part A & B (Medicare) to Part C (Medicare Advantage)
  • Changing from Medicare Advantage back to Medicare
  • Join, drop or switch a Part D prescription drug plan
  • Switch from one Medicare Advantage plan to another

After enrolling in Medicare, you could decide not to have Part B

You can enroll in Part B later, if you have coverage through your job or an actively working spouse.

  • If you were automatically enrolled in Parts A & Part B, and received a Medicare card, you can follow the instructions (included with the card) and send the card back. (Keeping the card means you will keep Part B)
  • If you enrolled in Medicare through Social Security, call Social Security member services at 1-800-772-1213 (TTY 1-800-325-0778).

If you want to enroll in a Medicare Part C (Medicare Advantage) plan, it works in place of your Medicare Parts A & B. However, you must enroll in Parts A & B first. Then you can enroll in a Medicare Advantage plan. You can do this during specific times:

  • If you are new to Medicare – Initial Enrollment Period (IEP), the 7-month period when you are first eligible for Medicare. After you enroll in Parts A & B, you can choose to enroll in a Medicare Advantage plan.
  • If you’ve already enrolled in Medicare Parts A & B, you can choose to enroll in a Medicare Advantage plan, or disenroll, each year between October 15 and December 7 (Annual Open Enrollment for Medicare Advantage and Prescription Drug Plans).

The date your Medicare Advantage coverage starts will depend on your enrollment period. It is wise to keep your original coverage until your Medicare Advantage coverage begins.

If you choose a Medicare Advantage Plan, instead of Medicare and cancel a Medicare Supplement plan, and you decide later to want the Medicare Supplement Plan back, you may need to pass medical underwriting.

Changing Medicare Advantage Plans

If you want to switch between one Medicare Advantage plan and another, generally you’ll need to do it during Annual Open Enrollment for Medicare Advantage & Prescription Drug Plans, between October 15 to December 7.

Once you select a new Medicare Advantage plan, your old Medicare Advantage coverage will automatically stop once your new Medicare Advantage coverage begins. You don’t need to do anything to cancel your previous plan. This only pertains to switching from one Medicare Advantage plan to another.

Changing from Medicare Advantage back to Medicare Parts A and B (Medicare)

Twice per year, you have an opportunity to switch from Medicare Advantage back to Medicare:

  • Annual Open Enrollment for Medicare Advantage & Prescription Drug Plans (Oct. 15 – Dec. 7)
  • The Medicare Advantage Disenrollment Period (Jan. 1 – Feb. 14)

In the Medicare Advantage Disenrollment Period, you will have until Feb. 14 to add a Part D prescription drug plan. Your coverage will start on the 1st day of the month after the month you switched coverage.

Switching from Medicare Advantage back to Medicare with Medicare Supplement Coverage

You can choose a Medicare Supplement plan, during your Medicare Supplement Open Enrollment Period, when you first become eligible for Medicare, without medical underwriting.

There are a few situations that allow you to get a Medicare Supplement plan without medical underwriting, if you decide to switch back to Medicare, from a Medicare Advantage Plan. Here are a couple of situations:

If you joined Medicare Advantage during your Initial Enrollment Period, at age 65, and you don’t want to keep the plan, within 12 months of joining Medicare Advantage you can return to Medicare, and buy a Medicare Supplement policy.

If you move to a different state, or a different part of your state, and your Medicare Advantage plan doesn’t offer coverage in that area, you have special rights to return to Medicare and an optional Medicare Supplement plan or enroll in a new Medicare Advantage plan.

Switching Part D Prescription Drug Plans

Most people are allowed to switch plans once a year, during the Annual Open Enrollment Period for Medicare Advantage and Prescription Drug Plans (October 15 – December 7).

However, if you qualify for a program, providing extra help with your Medicare prescription drug costs, you can switch plans as often as once a month.

There are special circumstances * when you can switch plans at other times:

  • If you move out of your current plan coverage area
  • If you enter, leave or currently live in a nursing home
  • If your current plan changes and no longer serves your area
  • If you qualify for, and get Extra Help with your Medicare prescription drug costs.

*Note: There are other circumstances that may allow further options.

Mid-Year Drug Plan Formulary Changes

Part D plans sometimes change their formularies during the year. This happens because:

  • New drugs come on the market
  • New drugs are taken off the market
  • Generic versions of a brand name drug becomes available
  • New clinical guidelines, about the use of a medication, are announced

Part D plans are required to provide 60 days prior notice, to all members, when there are formulary changes.

Changing Medicare Supplement Plans

You can apply for a Medicare Supplement plan anytime you wish. There are no special enrollment periods or strict guidelines affecting enrollment timing.

There are, however, guidelines about acceptance and guaranteed approval, no matter your medical condition.

Medicare Supplement policies come in a variety of types and have multiple rates attached and different coverages.

These policies are standardized, which means, if you get a Plan G and want to switch, all other plans G will be the same coverage. The only difference would be the price and company administering it.

What to do with your Medicare Supplement coverage if you get a job

If you get other health insurance, you may be able to put your Medicare Supplement policy on hold or *suspend it. You can suspend your Medicare Supplement policy if:

  • You have Medicare and a Medicare Supplement policy when you are under age 65 and you go back to a job that offers health insurance, or
  • You are the dependent, spouse or adult child of someone who gets a job that offers health insurance.

*The right to suspend your Medicare Supplement policy, if you get employer health insurance, is only for people with Medicare and who obtain a Medicare Supplement prior to age 65. You do not need to be under age 65 to exercise your right to suspend. See page 40 of the “Guide to Health Insurance for People with Medicare” provided by Medicare.gov, CMS Product No. 02110.

You will need to contact your Medicare Supplement insurance company and let them know. You can suspend your Medicare Supplement:

  • At any time while you have employer group health insurance, and
  • As long as you are eligible to get Medicare because of a disability.

If you lose your job’s health insurance coverage, you can get your Medicare Supplement back. You will need to inform your Medicare Supplement company within 90 days of losing your job’s coverage. Your Medicare Supplement coverage will begin the day you lost your job’s coverage.

Suspending a Medicare Supplement policy if you get Medicaid

You can put your Medicare Supplement policy on hold, or suspend it, within 90 days of getting Medicaid. You send the company a letter to suspend your policy. Your insurance company can tell you exactly what to say in your letter and where to send it.

You can suspend your Medicare Supplement policy for up to 2 years. Some people choose to keep their Medicare Supplement policy active so they can see doctors that do not accept Medicaid. This can be expensive, so carefully consider if you need both.

If you already have Medicaid, an insurance company cannot by law sell you a Medicare Supplement policy except if:

  • Medicaid pays your Medicare Supplement premium, or
  • Medicaid only pays all or part of your Medicare Part B premium.

BACK: After-Enrollment Checklist