• Wiser Medicare

The Pros and Cons of Switching Plans During the Open Enrollment Period

Updated: Oct 27


The 2023 Open Enrollment Period runs from October 15 to December 7 and allows you to join, switch or drop a Medicare-related health care plan. Several possible plan changes are available, as described in “Are You Ready for the 2023 Open Enrollment Period?”


Any changes made during the Open Enrollment Period take effect on January 1 of the following calendar year. On the other hand, if you make no changes, your coverage will renew automatically (integrating any benefit or cost changes that were announced in your insurer’s Annual Notice of Change letter in September).


Today we’ll look at the pros and cons of making each possible change.


If you’re switching from Original Medicare to a Medicare Advantage plan


Pros:

  • Your out-of-pocket expenses will have an upper limit.

  • You will have access to many additional benefits, such as dental, vision, hearing, fitness and others.

  • You may get a monthly stipend to spend on over-the-counter products.

  • You may access supplemental home health benefits such as personal in-home support services, transportation to medical appointments, adult daycare services and meal delivery.

  • Your plan will likely include prescription drug coverage, making a standalone Medicare Part D plan unnecessary.

  • You can change plans easily each year to reflect your changing health care needs.

  • You have an additional period between January 1 and March 31 each year to change your Medicare Advantage plan.

Cons:

  • The benefits and coverage of Medicare Advantage can change from year-to-year, forcing you to replace plans if changes are unacceptable.

  • You will be limited to using just the doctors and medical facilities in the plan’s network or pay more to see out-of-network providers.

  • You may need referrals from a primary physician to see specialists and prior authorization for certain health care services, which can lead to delays or denials.

  • If you travel away from your home area, you may only be able to use doctors and hospitals for emergency reasons (and only until you are “stable”) or pay the cost yourself.

  • You may have to change plans if you ever move since most Medicare Advantage plans have limited service areas.


If you’re switching from a Medicare Advantage plan to Original Medicare


Pros:

  • The benefits and coverage of Original Medicare do not change from year to year (except for those related to a Medicare Part D prescription drug plan you might buy).

  • You can choose any doctor or hospital nationwide that accepts Medicare.

  • You don’t need referrals to see specialists.

  • You are more likely to receive care in the highest-rated hospitals or highest-quality skilled nursing facilities and home health agencies.

  • You have an additional period between January 1 and March 31 each year to switch to Original Medicare from your Medicare Advantage plan.

  • You will not have to change plans if you ever move since Original Medicare offers nationwide coverage.

Cons:

  • Your coverage will be limited to 80% of Medicare-approved costs, so you will pay the 20% balance after the deductible unless you buy a supplement insurance (Medigap) plan for an added premium.

  • Without a Medigap plan, there’s no cap on your annual out-of-pocket costs.

  • You will need a standalone Medicare Part D prescription drug plan – with its separate premium, deductible and shared costs – to cover your medications.

  • Unless you have special circumstances, you may have to undergo medical underwriting to get a Medigap plan and possibly be refused or penalized for preexisting conditions.

  • You may lose supplemental home health benefits such as personal in-home support services, transportation to medical appointments, adult daycare services and meal delivery.


If you’re switching Medicare Advantage plans


Pros:

  • You may find lower costs for premiums, coinsurance, copays, deductibles or out-of-pocket maximums.

  • You may find more of your doctors or hospitals in a new plan’s network (or better ones), including to replace those who have left your network.

  • A new plan may cover more of your prescription drugs or at better prices.

  • You may find more (or better) extra benefits with another plan.

  • You may find a more convenient preferred pharmacy network or drug delivery option.

  • You may be able to lower premiums and other costs by finding a plan that covers only what you actually use and not unused extras.

  • Changing from an HMO to a PPO plan can give you greater flexibility.

  • Changing from a PPO to an HMO plan can lower your costs.

Cons:

  • You may find that – to get one of the “pros” listed above – you have to give up another.

If you’re switching the standalone Medicare Part D prescription drug plan you added to Original Medicare


Pros:

  • You may find lower costs for premiums, coinsurance, copays, deductibles or out-of-pocket maximums.

  • The new plan may cover more of your prescribed medications or at better prices.

  • You may find a more convenient preferred pharmacy network or drug delivery option.

Cons:

  • You may find that – to get one of the “pros” listed above – you have to give up another.

Only around 10% of Medicare beneficiaries switch their insurance plans during Open Enrollment. Unfortunately, that means millions of people could miss out on saving money – and enjoying better benefits and health care choices.

 

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