Janell Sluga
This month’s Guest Blogger is Janell Sluga, a licensed Medicare & Individual Health Insurance Account Executive, from Lawley Insurance. Janell is a part of Lawley Medicare Solutions which is a non-government entity helping those eligible for Medicare insurance understand the various plans available to them and find the Medicare insurance plan that best matches their needs.
Here are some questions to help understand Medicare Advantage Open Enrollment Period.
1. What is Medicare Advantage Open Enrollment Period (MA-OEP)?
Many of us are aware of Medicare’s Annual Open Enrollment Period, which runs from October 15 to December 7 each year. However, you may not be familiar with the Medicare Advantage Open Enrollment Period (MA-OEP), which takes place from January 1 to March 31. This three-month opportunity is for individuals with a Medicare Advantage Plan, allowing them to switch to any other type of insurance product they choose, with or without drug coverage. During the January to March Enrollment Period, you can switch from one MA Plan (with or without drug coverage) to another MA Plan (with or without drug coverage), or from Medicare Advantage to Original Medicare with a Stand-Alone Drug Plan (PDP), or even to Original Medicare with no drug coverage. The MA-OEP is certainly one of the ways to switch your insurance right now until March 31! That’s why you’ll continue to see commercials on TV, receive mail from, and possibly get calls from Medicare Advantage Plans.
2. Why would I need to switch plans during MA-OEP?
The MA-OEP is also helpful for individuals who decide they no longer want to stay in their Medicare Advantage Plan for any reason. One reason could be an increase in premiums or co-pays. Another reason could be that your doctor, hospital, or pharmacy no longer participates in the Medicare Advantage Plan you thought you wanted to keep. People sometimes switch out of MA Plans because of serious medical conditions, such as cancer or renal failure, which may be better covered by Original Medicare.
You may also want to switch your plan if you have gone to the pharmacy recently and found that your medications are more expensive than you expected, or more expensive than last year. Even though you chose not to switch your insurance, the insurance company may have made changes that impact you. Evaluating your insurance choice before it’s too late could help you save money, as you may be locked into your plan for the year after April 1.
3. How do Medicare Advantage Plans (MA) work?
Medicare Advantage Plans (MA) are plans that replace your Original Medicare benefits and usually include prescription drug coverage. This includes options such as HMO (Health Maintenance Organizations), PPO (Preferred Provider Organizations), and PFFS (Private Fee For Service) plans. Each year, insurance companies adjust the coverage of their MA plans, including premiums, co-pays, deductibles, extra benefits, and more. As a result, the plan you let roll over may differ from what you expected. There are over 45 MA Plans in the WNY region. While this is fewer than in previous years, it still offers many options. Each plan has different monthly premiums, co-pay structures, and networks of providers, so I will speak broadly about this situation.
4. If I change my mind, can I return to my previous plan?
If you decide to return to Original Medicare insurance, but I always stress the importance of evaluating the option of adding a Medicare Supplement Plan if this is the case. In New York State, you can enroll in a Medicare Supplement Plan at any time. There are no pre-existing condition limitations because you are transitioning directly from one product to another, and the “pre-existing condition” clause does not apply to you.
5. Is there anything else I should consider when evaluating plans?
It’s also important to remember that if you drop a Medicare Advantage Plan and return to Original Medicare, you should seriously consider adding a Medicare Supplement Plan. Leaving your HMO, PPO, or PFFS plan will default to your Original Medicare coverage, but you will need to actively enroll in both a Drug Plan and a Medicare Supplement Plan. These options do not happen automatically, but the Medicare Consultants at Lawley Insurance can help! If, for any reason, you chose not to include drug coverage in your current Medicare Advantage Plan, you can now change that choice from January 1 to March 31.
6. When would my new MAP begin?
During this period, your new coverage will begin the first of the following month. If you change your insurance in March, your new plan will begin on April 1. This is significant because, after April 1, you may be locked into your plan for the rest of the year without a Special Enrollment Period (SEP) available to you.
7. Who Can I Work With to discuss my options?
At Lawley Medicare Solutions, we offer personalized service and expert advice tailored to your unique situation to ensure you’re getting the best coverage for your needs. To schedule a consultation, you can reach me via phone at 716.489.2983 TTY-711 or via email jsluga@lawleyinsurance.com
Our licensed Medicare & Individual Health Insurance team can help clients understand the details of Medicare insurance plans, assist with choosing the right benefits and coverage, and provide guidance when life events that affect health coverage occur. Working with an independent insurance agent can break down Medicare insurance options into simple terms and help an individual navigate through the Medicare insurance enrollment period. Independent licensed insurance agents often represent a variety of insurance carriers, which may all have different plan options available, depending on the service area.
Lawley Medicare Solutions has independent, licensed, and certified insurance agents that can help you find the plans that best fit your needs. Visit lawleyinsurance.com for more information
