Know your options

Rules for Joining or Switching a Medicare Plan

Which Option is Right for You?

There are very distinct rules and guidelines as to when you can join or switch a Medicare plan without having to pass a health screening exam. This is important to understand when you first want to enroll in a Medicare plan. The reason for these guidelines is to prevent people from only selecting a more comprehensive plan when they are in need of more complete medical coverage. If you were able to switch plans at anytime, people would only stay on Original Medicare if they are healthy and then move to a better plan once they become ill or need costly prescription drugs. In addition to date deadlines, there may also be geographical restrictions and other considerations that prevent you from switching or joining a plan at anytime.

You can join Medicare Advantage Plan or other Medicare Health Plan only if you live in the service area of the plan. Many of these types of plans work with a specific network of physicians and hospitals and you may not have access to this network if you live outside of the geographical boundaries. You must also first have Medicare Part A and Part B before you can enroll in either of these plan types. You may not qualify for a Medicare Advantage Plan if you have permanent kidney failure that requires a transplant or dialysis.

You can initially join a Medicare plan when you become eligible for Medicare. You will first become eligible to enroll in Medicare starting 3 months before the month you turn 65 and ending 3 months after the month you turn 65. If you are getting Medicare because of a disability, you can join 3 months before and after your 24th month of cash disability benefits. If you do not enroll during this period, you are not eligible to enroll again until November 15th. Once you enroll in a plan, it is generally for the calendar year. Joining a new plan outside of these time frames may require that you pass a brief series of health questions and eligibility or enrollment is not guaranteed.

There are few exceptions to this rule, one of which is relocation. If you are on a Medicare Advantage Plan and you move outside of the service area, you are eligible to switch plans to a new plan that is offered in your new area. If there are no Medicare Advantage plans available in your new area, you may enroll in a Medicare Supplemental policy or any other type of Medicare plan that is available in your new area.

You can join a Medicare Prescription Drug Plan if you have the Original Medicare Plan, a Medicare Private fee-for-Service Plan, or a Medicare Cost Plan. Generally, you can only enroll in one type of Medicare plan at a time. If you currently have a Medicare plan and enroll in another plan, you will automatically be un-enrolled in your current plan. This also applies to prescription drug plans.

For 2006, if you currently have a Medicare plan that provides prescription drug coverage, and you do not enroll in a different plan by June 30th, you will only be able to switch to another plan that includes prescription drug coverage. There may also be a 1% per month penalty that applies to late enrollment. If you receive full Medicaid coverage from your state, you can join or change a plan at any time.

When joining or switching to a different Medicare plan, make sure to compare all of the programs available in your area.

If you currently have a Medigap policy you can still join a Medicare advantage plan or other Medicare Health Plan. However, this may not make sense because you will still need to continue making the monthly premium payments. You may not get the benefits from it while you are in a Medicare Advantage Plan or other Medicare health plan, since these plans will cover most of your major medical expenses. If you join a Medicare Advantage plan you will have to pay a co-payment and deductibles, and you Medigap policy will not pay for these share-of-costs associated with your other plan. If your plan covers prescription drugs and you have a Medigap policy that covers prescription drugs, the drug coverage must be removed for the Medigap policy, and your premium reduced If you drop your Medigap policy you may not be able to get it back. If you join a Medicare Advantage Plan or other Medicare health Plan when you are first eligible for Medicare at age 65, you may have some special Medigap protections that give you a right to get your old Medigap policy back or buy a new one later if you have left your plan within the first year. You may also join a Medicare Prescription Drug Plan at that time.

If you join a Medicare Advantage Plan while you are still insured under an employer group plan or union coverage, you may still be able to use this coverage along with your plan.

You can only change plans under certain circumstances. You can choose to change your current plan from November 15 through December 31 of every year. This 6 week time frame is what is referred to as "open enrollment" and any plan changes are set for the calendar year. You can switch your plan by contacting your insurance company to see what other options they have available. Or, you may switch your coverage to a different insurance company altogether.

If you want to cancel your current Medicare Advantage plan and move to a Medigap policy, you must contact your insurance company to provide notification of your intent. Simply enrolling in a Medigap policy won't automatically cancel you from the Advantage Plan. Remember, prescription drug coverage will not be available on Medigap polices after January 1, 2006. If you switch from one Medicare Advantage plan to another or other Medicare Health Plan, you will be cancelled by the previous plan automatically. However, it is always a good idea to notify your previous insurance company that you have switched plans.

If you are on a Medicare plan, and that plan leaves your area, your plan will send you a letter letting you know what your options are. Usually, you will automatically be eligible to switch to another plan. You will also be eligible to join the Original Medicare plan if this occurs. This rule also applies if your insurance company decides to withdraw from the Medicare program or pulls out of your service area.. If you are on a Medicare Advantage plan, you will be automatically returned to the Original Medicare Plan if you don't join another Medicare Advantage Plan or other Medicare health Plan.

If your Medicare plan pulls out of your service area, and there are no other Medicare plans available for you in your area, you may be able to keep your benefits under your plan. However, you may need to travel to a physician or hospital that is in one of the areas where this plan is still offered and has a network of participating health care providers.

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