Joanne: If you find yourself enrolled in a Medicare Advantage plan and you're looking to change to a new Medicare Advantage plan or even to a Medicare Supplement plan, it's crucial to understand when and how you can make these changes, as well as what the process of changing actually looks like. Fortunately, we're going to cover all of these topics in today's episode.

Cameron: But before we start, my name is Cameron Giardini. Together with my cohost, Joanne Giardini Russell, we operate Giardini Medicare, an independent insurance agency based in Southeast Michigan. Although we are based in Michigan, we work virtually over the phone to help consumers in about 13 states find the right Medicare coverage for them.

If we do not work in your state, we will connect you with another trusted independent agent who will be able to help you find the coverage you want. We also have a free online course available for you that you can register for. You can do this by going to gmedcourse.com where we have hundreds of different Medicare topics.

So, for an overview of this episode, first, we will talk about an overview of actual Medicare Advantage plans and what they are, just a brief reminder. We'll talk about the different options you have for changing Medicare Advantage. We'll also talk about when you can make these changes to your Medicare Advantage coverage, and we will talk about the process of making these changes, which includes changing from one.

Medicare Advantage plans to another or changing from a Medicare Advantage plan to a Medigap plan with also having Part D coverage. But Joanne will get us started with a brief overview of Medicare Advantage plans. 

Joanne: Medicare Advantage plans are often referred to as Part C, but they are not part of Original Medicare and are not provided by the federal government.

Instead, the government funds private insurance companies to offer Medicare Advantage plans to consumers as a private alternative to Original Medicare. So, Medicare Advantage plans are considered bundled plans, and they provide Part A, Part B, and usually Part D coverage all in one plan.

These plans also become your primary coverage, so while you are enrolled in a Medicare Advantage plan, you will not be using your red, white, and blue Medicare card for most services. However, Medicare Advantage plans must cover all of the services that Original Medicare covers. So, these plans are managed care plans, and they most often come in the form of an HMO or a PPO.

This means that, unlike with original Medicare, you will have a network of contracted providers and facilities that you might be limited to with your Medicare Advantage plan. Because these are managed care plans, prior authorization is much more common with Medicare Advantage plans compared to original Medicare with Medigap coverage.

And that means your providers may need prior approval before certain services can be completed. 

Cameron: Yeah, it's always a good reminder to remember what Medicare Advantage plans are. If you need a deeper dive into that, you can always check out our YouTube channel or our TikToks or listen to our previous podcast episodes, especially the ones where we talk about Medicare Advantage versus Medigap plans.

But with that out of the way, we're going to move to option number one, which is changing from one Medicare Advantage plan to another Medicare Advantage plan. So overall, when it does come to change from one to another, we'll briefly talk about the general process and what it looks like. First, it is important to know that when you're applying for Medicare Advantage coverage, this does not require that you answer health questions or qualify based on your current health status or pre existing conditions.

As it might when you're applying for Medigap plans, know that you will still have to give out your personal information, like your Medicare ID number, your name, your address, and more. So please do not give out any of that information to anyone over the phone or in person unless you are comfortable enrolling in a plan through that person, if they're a broker, or through that company.

Also, know that enrolling in a new Medicare Advantage plan will cause your current Medicare Advantage plan to be canceled once Medicare processes the new enrollment. Luckily, once the new plan is set to take effect, this won't cancel, like I just said, before your new one starts. So you won't have to worry about gaps in coverage but know you're not going to have two plans at the same time.

So, if you're listening to this episode and you just recently enrolled in Medicare and a Medicare Advantage plan for the first time, you may have a unique opportunity to change to a different Medicare Advantage plan using a lesser-known enrollment period, which is called the new Medicare Advantage open enrollment period, which is a bunch of words. Still, we will just shorten it to OEP new, and we'll explain what it means.

This is a one-time election period, covering the first three months of enrollment in both Part A and Part B of Medicare. It can be easy to confuse this with your initial enrollment period, or IEP, which we talk about in other episodes, so we'll provide an example of this new OEP. For our example, we have David, who applies for Medicare Advantage with Company X, effective August 1st.

This is the first day of the month he turns 65, and he used his initial enrollment period, or IEP, to do that enrollment. In this case, David has access to the OEP from August through October. Then, in September, David decides he wants to change to a new Medicare Advantage plan with company Y.

So then he submits an application for the new plan in September for an October 1st start date using his OEP-NEW. This application will automatically cancel his current plan through his Medicare Advantage plan with company X at the end of September, and then starting October 1st, he will be covered by his new plan with Medicare Advantage through company Y.

Once he's done that, he can no longer use his OEP to make another change. But moving on from that lesser-known enrollment period, we'll have Joanne now talk about some of the more common and set enrollment periods for Medicare Advantage changes. 

Joanne: Alright, this next enrollment period is probably the most popular for those of you who are enrolled in Medicare Advantage coverage and want to make a change.

This is called the annual election period. It runs from October 15th to December 7th, and as the name suggests, this enrollment period occurs yearly during this time frame. During this time of year, you can change from one Medicare Advantage plan to another, and the new plan will be effective January 1st of the following year.

You can make multiple plan changes during this time period, but the last Advantage plan you enroll in by midnight on December 7th will take effect in January, and this enrollment will automatically cancel the current Medicare Advantage plan you have at the end of December.

We then have something called Medicare Advantage OEP. So this enrollment period is easy to confuse with that OEP-NEW that Cameron just talked about, but this is a set enrollment period for current Medicare Advantage enrollees and this occurs every year from January 1st until March 31st. During this time period, you can make one change to a different Medicare Advantage plan if you would like to.

The new plan that you choose will be effective on the first day after the month that you apply. It will also cancel your current Medicare Advantage plan at the end of the month before your new plan begins. Last but not least, individuals may have unique opportunities to change from one Medicare Advantage plan to another.

Special enrollment periods are enrollment periods that are outside of the usual ones we just discussed, and they're normally triggered by specific life events like moving or being eligible for Medicaid or extra help or maybe enrolling into a five-star plan and many more situations. These special enrollment periods will typically occur during a set time frame.

based on that qualifying event. For example, if you moved out of your Medicare Advantage plan's service area, you can apply for a new plan one month before and up to two months after your move. 

Cameron: Yeah, it's always just good to remember these overall different timelines for moving from one Medicare Advantage plan to another because you just need to understand that you're not stuck with one plan.

So keep these in mind. If you have to go back and listen every once in a while, it's always good to have a refresher. But now we'll shift to the other side of things, which is option two, and that is changing from a Medicare Advantage plan to a Medigap plan or a Medicare supplement. So overall for the process, when doing this, there are two things that are generally important to know when it comes to making this change.

First, you have to be able to qualify for the Medigap plan, and you also need to have a valid enrollment period to both disenroll from your Medicare Advantage plan. And you need to actually enroll in a Part D plan to go with your new Medigap plan so that you have proper prescription drug coverage.

First, we need to check if you have access to your Medigap Open Enrollment Period. We have talked about this a lot because it's super important, but your Medigap OEP, or Open Enrollment Period, is a one-time enrollment period that occurs during the first six months you are 65 or older, and you are enrolled in Medicare Part B for the first time.

During this Medigap OEP, you can enroll in any Medigap plan letter you are eligible for without being charged a higher premium or denied coverage based on your health conditions or pre-existing conditions. Now, if you do not have access to your Medigap OEP, you may have another possible opportunity to enroll in a Medigap plan without health or pre-existing condition exclusions or restrictions, and that might be due to guaranteed issue rights, which are granted in certain situations when your coverage changes.

We will link to a full list of these guaranteed issue rights for Medigap coverage and the different situations. We'll do that in the show notes. But as an example of this, one of these opportunities that may be available is if you are moving outside of your Medicare Advantage plans. service area. Now, also, in a handful of states, you may have additional guaranteed issue rights that are available to you.

So always reach out to a broker familiar with the plans and the rules in your estate if you're looking to go from Medicare Advantage to a Medigap plan. Last but not least, if you are outside of your six-month Medigap OEP. And you do not have access to any guaranteed issue rights like we talked about.

If you do want to change from a Medicare Advantage plan to a Medigap plan, you will very likely have to go through medical underwriting to qualify for that Medigap plan. Medicare defines medical underwriting as the process that an insurance company uses to decide, based on your medical history, whether to take your application for insurance.

Just know that if you do have to go through underwriting to get a Medigap plan, your acceptance in the plan is not guaranteed, and you may be charged a higher premium or just even denied enrollment into the Medigap plan based on your current health and pre-existing conditions. But when can you do this? Joanne will talk about that. 

Joanne: All right. Now that we've discussed the options to enroll in or qualify for a Medigap plan, the timing for when you might be able to change from Medicare Advantage coverage to Medigap and Part D coverage will be similar to the ones we've previously discussed.

This will generally include the fall annual election period. The Medicare Advantage open enrollment period, including that OEP new, or during special enrollment periods due to qualifying events. Now, because the timing and the mechanics of changing from Medicare Advantage to Medigap and Part D coverage can seem overwhelming when you look at all the possibilities at once, we will end our discussion today with an example of changing from a Medicare Advantage plan to a Medigap plan plus a Part D plan.

We will also use probably the most common example, which is making this change during the fall annual election period. So, in this case, let's pretend James is enrolled in a Medicare Advantage plan, and in early November, he decides he wants to leave that Medicare Advantage plan, and he wants to return to Original Medicare along with Medigap and a Part D plan.

Although it is at the annual election time, James still has to go through medical underwriting to qualify for the Medigap plan since he is outside of his Medigap open enrollment period and he doesn't have guarantee issue rights. So, in this case, James is going to fill out an application, including and answering the health questions for a Medigap Plan N for an effective date of January 1st.

 A couple of weeks later, in mid November, James is notified that he was approved for the new Medigap Plan at the preferred price, and he wants to move forward with this coverage. So, at that point, he's going to apply for the Part D plan based on his prescriptions using the annual election period, and then this new plan is going to become effective on January 1st as well.

So, the Part D plan that he files will then cancel the Medicare Advantage plan, and both his Medigap and his Part D plan are going to start on January 1st with Original Medicare being primary. 

Cameron: Yeah, absolutely. Always remember when you can do things and how the process works. Of course, you can always let us know if you have any questions, but it's just good to get that general overview, and we will have another episode for those of you with Medigap plans who are looking to make a change.

So overall, it's just important not to feel stuck with Medicare Advantage coverage or any coverage you have with Medicare. Eventually, over time, plan coverage will change. So will your wants and your healthcare needs. With the overall guide from this episode, hopefully, you will now be able to confidently review your Medicare Advantage coverage when you need to make any necessary changes.

As always, please leave us a review on your podcast app and subscribe so you can listen to future episodes. You can find more Medicare content from us by going to YouTube and searching Giardini Medicare, or you can do the same on TikTok. Last but not least, if you want to schedule a phone call with one of our licensed brokers, you can do that by going online to gmedicareteam.com or sending us any questions to info@gmedicareteam.com. Thank you, and have a great day.