Switching Medicare plans can be a good move, and it can also create problems that are hard to undo until the next enrollment window. The difference usually comes down to whether you asked the right questions before switching Medicare plans, not after. The Annual Enrollment Period runs October 15 through December 7, and changes take effect January 1, so there is time to ask them.
This article is educational only. Medicare.gov and 1-800-MEDICARE (TTY 1-877-486-2048) are the official sources for plan and coverage information.
Below are the questions we encourage people to work through, in roughly the order they come up. Bring them to any conversation with a plan, an agent or 1-800-MEDICARE.
Questions About Your Current Plan
1. What exactly is changing in my plan next year?
Your Annual Notice of Change, mailed in September if you have a Medicare Advantage or Part D plan, lists the changes for the coming year. Read it before shopping. Sometimes the answer to whether you should switch is right there, and sometimes it shows the changes are minor.
2. What is the specific problem I want to solve?
Write it in a sentence. A higher copay for specialists, a drug that moved tiers, a doctor who left the network. A clear reason keeps the comparison focused, and it helps you avoid switching for something that sounded appealing in an ad but does not change your actual care.
Questions About Doctors and Hospitals
3. Are all my must-keep doctors in the new plan’s network next year?
Check each one in the plan’s provider directory for the coming year, and call the offices to ask which plans they expect to accept. Do not rely on last year’s directory or a friend’s experience.
4. Do I need referrals, and how does out-of-network care work?
HMO and PPO plans handle referrals and out-of-network care differently. If you see several specialists, or want flexibility, this question matters. Original Medicare works differently again, since it does not use networks in the same way.
5. What happens when I travel?
Many South Florida residents spend part of the year up north, or travel to see family. Ask how the plan covers routine and urgent care outside its service area. The answer varies a lot between plans and paths.
Questions About Prescriptions
6. Is every one of my medications covered, and on what tier?
Check each drug by name and strength on the plan’s formulary. Note the tier and whether there are restrictions such as prior authorization, step therapy or quantity limits.
7. What will my drugs cost at my pharmacy?
Plans often have preferred pharmacies with lower cost-sharing. Ask how your pharmacy is treated, and whether mail order would cost less for maintenance drugs. The Medicare Plan Finder on Medicare.gov can estimate this when you enter your pharmacy.
Questions About Cost
8. What would a realistic year cost, and what about a hard year?
Add up premiums, the deductible if any, copays for the visits you expect, and drug costs. For Medicare Advantage plans, look at the out-of-pocket maximum as your ceiling in a tougher year. Keep in mind that most people continue paying the Part B premium regardless of the plan’s own premium.
9. Are the extra benefits ones I will actually use?
Some Medicare Advantage plans include extras such as dental, vision or hearing benefits. They can be useful, but check the limits, the network and what you would really use. An extra benefit should be a bonus, not the main reason for a switch.
Questions About the Switch Itself
10. What happens to my other coverage if I switch?
This one is easy to overlook. Enrolling in a new Medicare Advantage plan generally ends your old one when the new plan starts. Joining some plans can also end a stand-alone Part D plan, and Medigap policies do not work with Medicare Advantage. If you are thinking of moving from Medicare Advantage to Original Medicare with a Medigap policy, ask whether you would face health questions for the Medigap policy, since that can apply in some situations.
What If You Change Your Mind?
During AEP, if you enroll and then reconsider before December 7, you can choose again. The last enrollment submitted during the period is generally the one that takes effect. If you are in a Medicare Advantage plan on January 1, the Medicare Advantage Open Enrollment Period from January 1 to March 31 allows one change, either to another Medicare Advantage plan or back to Original Medicare, with the option to join a Part D plan.
Knowing that safety net exists can take some of the pressure off, but it is still better to get the decision right the first time.
Questions to Ask Anyone Helping You
If you work with an agent, it is reasonable to ask:
- Which plans in my county do you offer, and are there others you do not?
- How did you check my doctors and drugs against each plan?
- Can you show me the full-year cost estimate for each option?
A good agent will answer those directly. Independent brokers can compare several plans, but no broker offers every plan, and Medicare.gov and 1-800-MEDICARE can show all your options. For a general overview first, see our page on Medicare plans in Florida.
Frequently Asked Questions
What should I check before switching Medicare plans?
Start with your Annual Notice of Change, then confirm your doctors are in the new plan’s network for next year, your drugs are covered at your pharmacy, and the full-year cost fits your budget. Also ask how the switch affects any other coverage you have.
When can I switch Medicare plans?
The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. People in a Medicare Advantage plan can also make one change during the Medicare Advantage Open Enrollment Period, January 1 to March 31.
Will switching to a new Medicare Advantage plan cancel my old one?
Generally yes. Enrolling in a new Medicare Advantage plan usually ends your old plan when the new one starts. Confirm with the new plan or 1-800-MEDICARE if you also have a stand-alone Part D plan or a Medigap policy.
Can I go back to Original Medicare after Medicare Advantage?
Yes, during AEP or during the Medicare Advantage Open Enrollment Period from January 1 to March 31. If you want a Medigap policy as well, ask whether health questions may apply in your situation.
Are extra benefits a good reason to switch plans?
They can be part of the decision, but check the limits and networks first. Doctors, drugs and total costs usually have a bigger effect on your year than extra benefits do.
Work Through the Questions With Us
If you would like a licensed agent to go through these questions with you against the plans we offer in your county, call Maher Insurance Group at (866) 220-2834, or complete our short online questionnaire and we will follow up at a time that works for you.
Maher Insurance Group is a licensed independent insurance brokerage and is not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer. Contact Medicare.gov or 1-800-MEDICARE for information on all of your options.
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