Table of Contents
- Why You May Need a New Plan During Medicare Open Enrollment
- Pros and Cons of Switching Medicare Benefits for 2025
- How to Switch Medicare Advantage (Part C) Plans
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The Medicare open enrollment period is underway, and retirees and other beneficiaries have until December 7 to make changes to their coverage. During this time, you can choose from Original Medicare (Part A and Part B), which provides benefits directly from the government, or Medicare Advantage plans (Medicare Part C plans), which provide those same benefits but from private insurers, plus additional coverage for dental care, vision care and prescription drugs, depending on the plan.
With inflation squeezing many people’s budgets, a different Medicare plan could help cut costs. Switching plans could also be a necessity if your location or medical needs are changing.
“This year is a unique one given some of the economic pressures we’re seeing,” says Bob Rees, vice president of Medicare sales for health insurance marketplace eHealth.
Keep reading for reasons why you might need to get a new Medicare plan during open enrollment and how to switch Medicare benefits for 2025.
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While every Medicare beneficiary has the opportunity to change plans during the open enrollment period, it seems as though few take time to review their options. A 2021 report from KFF found fewer than a third of Medicare beneficiaries compared plans in 2019[1].
However, skipping this step could be a mistake, particularly if any of the following are true.
1. You’re Moving
Medicare Advantage plans typically serve a specific geographic area. If you move, it may be difficult to find providers who participate with your plan, and using out-of-network providers could result in significantly higher co-insurance costs.
“The Best Way And Cautions order tramadol online overnight vary, now plan often at the county level,” says Rees.
If you expect to move out of your plan’s coverage area but not until later in the year, you may want to keep your current insurance for now. Once you leave your plan’s service areas, there’s a special enrollment period that allows you to switch plans after you move.
2. Your Plan’s Network Is Changing and According Werfel, where can i buy tramadol online
Medicare Advantage plans often operate as health maintenance organizations (HMOs) or preferred provider organizations (PPOs), with a list of participating providers who make up their network. However, networks don’t necessarily remain the same every year.
Before you renew your current Part C plan, confirm that your preferred providers and health care facilities are still in network. Prescription drug formularies (the list of medications covered by your plan) can change as well. If your plan has a new formulary that excludes your medicine, you may want to change coverage during Medicare open enrollment.
3. You’ve Been Diagnosed With a New Condition
If you have a new diagnosis, such as diabetes or cancer, talk to your health care provider about what you can expect for treatment in the new year. Then confirm that any expected specialists or medications are included in your current Medicare Advantage plan.
4. Increasing Out-of-Pocket Costs
Sometimes a plan might change its premiums or out-of-pocket costs, which can be a sign that it’s time to find new coverage. Other Medicare Advantage plans may have lower premiums, and some don’t charge premiums at all.
“People often gravitate to (premium-free plans) as their first choice,” according to Rees. Before signing up for a plan simply because it doesn’t charge a monthly fee, though, check the co-payment requirements. Sometimes it’s better to pay a premium for a plan that covers more of your costs.
5. You Want More Benefits and Enjoy Re order tramadol online your weekend,
Over half of Medicare beneficiaries (50.4%) enrolled in Medicare Advantage plans in 2024, according to the Center for Medicare Advocacy[2].
Many Medicare Advantage plans provide coverage not found in Original Medicare, such as vision or dental benefits. They may also offer ancillary benefits, such as gym memberships or transportation coverage, says Rees.
Even if you’re happy with your current Medicare Advantage plan, it may be worthwhile to compare your options to see if more or better benefits are available elsewhere.
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6. You’d Like a Medigap Plan
Medicare beneficiaries can purchase Medicare Supplement insurance, also known as Medigap plans, to “fill the gaps” in Original Medicare coverage. They can also offer benefits not readily available through Part C, such as emergency medical care while traveling in foreign countries or additional coverage for skilled nursing facilities.
However, only those with Original Medicare can purchase a Medigap policy. So if you have a Medicare Advantage plan, you’ll need to switch coverage to Original Medicare before you can buy supplemental insurance.
Be aware that if you purchase a Medigap policy outside your initial enrollment period at age 65, you may be subject to medical underwriting, which means the insurance company providing the plan could adjust your premiums based on your health status, costing you more. As a result, a Medigap plan may not be available or accessible to everyone because they’re either denied coverage because of a health condition or offered an unaffordable rate.
7. You Prefer Original Medicare
While Medicare Advantage plans come with extras, such as coverage for additional services and ancillary benefits, Original Medicare has one significant advantage: It can be used anywhere.
With Original Medicare, you don’t have to worry about whether your favorite provider or hospital is in network. Among those who select Original Medicare, 40% cite more doctor, hospital and health care provider choices as their motivating reason, according to a survey conducted on behalf of The Commonwealth Fund, a foundation devoted to improving health care systems[3].
Those with diabetes may also want to consider Original Medicare, as it caps the monthly cost of insulin at $35. If you switch to Original Medicare, though, remember that you need to purchase a separate Part D plan for prescription drug coverage, including insulin.
Pros and Cons of Switching Medicare Benefits for 2025
How to Switch Medicare Advantage (Part C) Plans
If you’re ready to switch plans–or at least consider your options–you can do so in three simple steps.
1. Compare Plans
Start on the Medicare.gov website. The Centers for Medicare & Medicaid Services maintains a searchable database that allows beneficiaries to look for plans in their area and compare costs. You can also add your prescription drugs to the search to see which plans pay for your medications.
2. Talk to a Licensed Insurance Broker
You can also speak to a licensed insurance broker to compare your plan options.
“Make sure the broker has a wide selection of plans available rather than just one or two,” advises Rees.
Some websites, such as eHealth, allow users to search for plans on their own and then connect with a licensed broker to ask questions if needed. Rees says people should be wary of scammers who may try to take advantage of older adults. Ask for a person’s license number and be wary of anyone who charges a fee for their services.
“It doesn’t cost you anything extra to work through a licensed broker,” according to Rees.
3. Enroll in Your New Plan
Once you find a plan you like, simply enroll with the new provider to make the switch. Since all application data is sent through CMS, old plans are automatically canceled, says Rees.
Your new policy will take effect on January 1, 2025. And if you choose a Medicare Advantage plan and have second thoughts, there’s a special Medicare Advantage open enrollment period that runs from January 1 to March 31 each year. During this time, you can switch to a different Medicare Advantage plan once or change to Original Medicare.
