What Changes Should You Make to Your Medicare Coverage During AEP?

Written by Admin | Nov 21, 2024 3:39:29 PM

During the Annual Election Period (AEP), you have changes to consider making for your current coverage is not going to meet your health care needs for the upcoming year . Here are your options and the potential pros and cons of each.

Switch from Original Medicare to Medicare Advantage (and Vice Versa)

If you are already enrolled in Original Medicare, you have the option to switch to Medicare Advantage coverage. Combining all of the benefits of Original Medicare, Advantage also provides healthcare coordination to lower your total out-of-pocket costs for frequent care.

Functioning on an established network of healthcare providers, Advantage plans reduce rates for benefits such as checkups, vision, and hearing care not available under Original Medicare alone.

But, maybe you decide that you no longer need these benefits from your current Advantage plan—in that case, you may do the opposite and instead, switch from Medicare Advantage back to Original Medicare.

Switch from One Medicare Advantage Plan to Another

Perhaps you already have a Medicare Advantage plan—if that is the case, don’t feel like you are locked into it permanently.

There are 4 different types of Advantage plans, each with their own individual methods of coverage and benefits. If you want to sign up for an Advantage plan or switch from one plan to another, you will have to choose between these 4. These options include:

Special Needs Plans (SNPs)

Plans tailored to their group’s needs
Requires in-network care unless for emergencies or out-of-area dialysis
Offers full prescription drug coverage
Most require a primary care doctor
Check for limited membership requirements

Preferred Provider Organization (PPO)

Allows for out-of-network visits
Most cover prescription drugs
No primary care doctor required
Does not require specialist referrals

Health Maintenance Organization (HMO)

In-network care except for emergency visits, out-of-area urgent care, or out-of-area dialysis
Most cover prescription drugs
Most require a primary care doctor and specialist referral

Private Fee-for-Service (PFFS)

Allows out-of-network care by those who accept the plan’s terms
Prescription drug coverage depends on the provider
Does not require a primary care doctor
Does not require specialist referrals

Add or Switch From One Prescription Drug Plan to Another

Perhaps you also want prescription drug coverage on top of your Medicare Original or Advantage coverage. In that case, during AEP, you have the option to add a Prescription drug plan (Part D) to your current plan. Or, if you already have a prescription plan, you may also switch from one plan to another.

For every Part D plan, there is a formulary that determines your out-of-pocket costs for the drugs you need. If you find that your current plan has higher rates for your prescriptions than another plan, it may benefit you to switch during AEP.

What Changes Should You Make to Your Medicare Coverage During AEP?

Switch from Original Medicare to Medicare Advantage (and Vice Versa)

Switch from One Medicare Advantage Plan to Another

Add or Switch From One Prescription Drug Plan to Another

Considering Making Changes During AEP?

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