Why might I want to enroll in Medicare Advantage?

You might want to enroll in Medicare Advantage to receive cost savings on the coverage you need, or to expand the type of coverage you receive as part of your plan, or both.

To receive adequate prescription drug coverage through other Medicare plans, one has to be enrolled in Original Medicare plus Medicare Part D or some other Medicare SsSupplement IiInsurance plan. Through Medicare Advantage, it is often possible to bundle these costs at a lower rate and end up saving money. This depends on the plans available in your individual area.

Medicare Advantage is private insurance that comes in a variety of packages including as HMOs, PPOs, and SNPs. This means the types of coverage and extent of coverage can vary widely as well, but in some cases you can find a Medicare Advantage plan tailored to the health issues you need more help with.

When is the Medicare Advantage enrollment period?

You can enroll in Medicare Advantage only during specific periods. First, you can enroll during the Initial Enrollment Period that occurs during a seven month window—beginning three months before you turn 65, includes the month you turn 65 and become eligible for Medicare Parts A and B—and ends three months after you turn 65.

If you’re already enrolled in Medicare and have passed that window, you can switch to or switch between Medicare and Medicare Advantage plans during the Annual Open Enrollment Period (AEP). In 2020 the Annual Open Enrollment Period will be between October 15 and December 7. Medicare beneficiaries can add, change, or drop their Medicare Part D or Medicare Advantage plan coverage for the next year during this time.

There is a Medicare Advantage Open Enrollment period where you can switch to another Medicare Advantage plan, join a Medicare Prescription Drug Plan or switch to Original Medicare between Jan 1st and Mar 31st.

Finally, you can switch or start Medicare Advantage during a Special Enrollment Period, which usually happens because of a qualifying life event. Qualifying life events include moving, losing other insurance coverage, becoming eligible for Medicaid, becoming eligible for Extra Help for coverage of prescription drug costs, getting long-term care at a hospital or skilled nursing facility, or you want to switch to a plan with a 5-star quality rating. Rules for when you can change are different for each Special Enrollment Period. Quality ratings of Medicare Advantage plans are available on Medicare.gov. 

How can I prepare for enrollment?

To prepare for Medicare Advantage enrollment, think about what type of health coverage you need, and write a list of the prescription medication you want access to. Each Medicare Advantage plan will offer coverage for different types of prescription prescription drugs, so be sure to choose a plan and tier of drug coverage that includes whatever you need. You can look in each plan’s formulary to find out which drugs are listed.

After you have all the plans that cover what you need available, compare prices on the plans available in your area, to find the one that is most affordable out of those suited to your needs. Be sure to check State Health Insurance Assistance Programs as well as they might be able to help you with coverage or prescription drug costs in your area. Remember that you might qualify for the Extra Help program for prescription drug costs or for a Special Needs Plan for some specific conditions like diabetes.

What will happen if I don’t like my plan?

If you don’t like your new plan, you will most likely have to wait for the following year’s annual Open Enrollment Period to switch. The yearly Open Enrollment Period allows you to switch between Original Medicare, Medicare Supplement plans, Medicare Advantage plans, or other equivalent plans. In the case of switching to a new Medicare Advantage plan you are generally allowed one switch per year.

The exception is if you would like to enroll in a Medicare Advantage plan that has five stars as a quality rating—you can move up to one of these plans any time of the year.