There’s a reason older Americans are commonly drawn to Medicare Advantage plans. Not only do Medicare Advantage plans put a cap on out-of-pocket spending (which original Medicare doesn’t do), but they commonly offer supplemental benefits beyond what original Medicare covers.
For example, if you need a dental cleaning and you’re enrolled in original Medicare, you’re out of luck, since that’s not a covered service. Original Medicare also won’t pay for eye exams or hearing aids.
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Most Medicare Advantage plans, on the other hand, do cover these expenses. And you’ll also find that many Medicare Advantage plans offer fitness benefits and other perks that are useful to enrollees.
But that doesn’t make Medicare Advantage plans perfect. And there may be issues with your specific plan that are making it harder to get the care you need.
The good news is that it’s not too late to make changes to your Medicare Advantage coverage. But you’ll need to act quickly if you want that option.
There are a couple of opportunities during the year when Medicare Advantage enrollees can change their coverage without a special enrollment period. One is fall open enrollment, which runs from Oct. 15 through Dec. 7 each year. The other is Medicare Advantage’s own open enrollment period, which runs from Jan. 1 through March 31.
During either period, you can switch from one Medicare Advantage plan to another, or drop your Medicare Advantage plan completely and sign up for original Medicare instead. If you go the latter route, you’ll have an opportunity to join a separate Part D drug plan.
You should also know that during fall open enrollment, you can move from original Medicare to Medicare Advantage. But during the Medicare Advantage open enrollment period, you can’t sign up for a Medicare Advantage plan if you’re on original Medicare.
If you decide to make a change before March 31, your change will be effective on the first day of the following month. So things could happen pretty quickly.
There are a number of reasons to consider moving off of your Medicare Advantage plan. First, if you’re not happy with your provider network, that’s a good reason to make a change. If you don’t have access to providers you trust or who are easy to access, it could be an impediment to taking care of your health.
You may also want to move off of your Medicare Advantage plan if you find that your out-of-pocket costs are higher than expected. There may be another plan that has you spending less.
Finally, Medicare Advantage plans are notorious for requiring prior authorization for a host of treatments. These could force you to wait to get care, and, in some cases, result in denials. If that keeps happening to you, you may want to dump Medicare Advantage altogether.
Do be careful, though, if you drop Medicare Advantage completely. While you can always sign up for original Medicare, you may find that it’s costly and/or difficult to get onto a Medigap plan for supplemental insurance. And without one of these plans, you could be looking at very expensive costs in the forms of copays, coinsurance, and deductibles.
All told, there’s still time to make a change to your Medicare Advantage coverage. But don’t delay. You only have until the end of the month to put a new plan in place for 2025. Otherwise, expect to be stuck with your current coverage until 2026.
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