If you’re currently enrolled in a Medicare Advantage plan, you may have heard that these plans may no longer be offered. Since it can be difficult to parse fact from fiction, here’s an overview on the future of Medicare Advantage – and what to do if your plan stops being offered.
Is Medicare going away?
In a word—no, Medicare isn’t going away any time soon, and Medicare Advantage plans aren’t being phased out.
The Medicare Advantage (Part C) program is administered through Medicare-approved private insurance companies. Medicare Advantage plans (such as HMOs and PPOs) must cover at least the same level of coverage as Original Medicare (except for hospice, which is still covered through Part A). Many plans also cover extra benefits, such as prescription drugs, routine vision, dental coverage, or hearing services.
While there are no current plans for the Medicare Advantage program to be phased out, in some situations, your Part C coverage may end through no fault of your own. Sometimes, private insurance companies may decide to no longer offer specific plans in certain service areas:
Your Medicare Advantage plan may end coverage for a variety of reasons:
- Your plan leaves the Medicare program.
- Your plan is no longer being offered in your service area.
- Medicare terminates its contract with your plan.
- Medicare chooses not to renew your plan’s contract.
If your plan is ending coverage, you’ll get a notice from your plan. If your coverage is ending for the upcoming calendar year (starting January 1), you should get this notice by early October. You’ll be eligible for a Special Election Period (SEP) to enroll in a new Medicare Advantage plan, if you choose to do so. This is your chance to make changes or enroll in new coverage outside of the regular enrollment periods. Your SEP runs from December 8 of the current year until the last day of February of the following year.
If your Medicare Advantage coverage is ending because Medicare ended your plan’s contract, your Special Election Period starts two months before your coverage ends and lasts one full month after your plan’s contact ends.
What are my options if my Medicare Advantage plan is ending?
If your Medicare Advantage coverage is no longer available, you have a few options:
You can enroll in a different Medicare Advantage plan. If you like your insurance company but your plan is ending, find out if your Medicare Advantage plan offers a similar plan in your service area. If not, and you still want to stay with Part C, you can switch to a different Medicare Advantage plan offered by a different company, if available.
If you’re eligible for a Special Election Period, make sure to pay attention to how much time you have to choose a new plan so that you don’t have a lapse in coverage. Special Election Periods vary in length depending on the reason you’re eligible; if you’re not sure, contact Medicare for more information at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.
You can switch back to Original Medicare and enroll in a Medicare Prescription Drug Plan. In general, if your plan leaves Medicare and you don’t enroll in a different Medicare Advantage plan, you’ll be automatically returned to Original Medicare. If you had prescription drug coverage as part of your Medicare Advantage plan, it’s important to also enroll in a stand-alone Medicare Prescription Drug Plan, since Original Medicare doesn’t automatically include prescription drug benefits.
You may be able to enroll in a Medicare Supplement plan. If you decide to switch back to Original Medicare, consider whether you want to add on Medicare Supplement coverage. If you’re losing your Part C coverage because your plan is leaving the Medicare program or no longer being offered in your service area, you’ll have a guaranteed-issue right to buy a Medicare Supplement plan if you return to Original Medicare. You’ll be able to enroll in any Medicare Supplement Plan A, B, C, F, K, or L offered by any insurance company in your service area.
When can I enroll in a Medicare Advantage plan?
Unless you have a specific situation that qualifies you for a Special Election Period, you’re usually only able to enroll or make coverage changes during certain times.
- Initial Coverage Election Period: this is the period when you’re first eligible for Medicare Advantage, which typically takes place at the same time as your Initial Enrollment Period for Part B. It starts three months before you’re eligible for Medicare, includes the month you become eligible, and lasts another three months after that. For most people, your eligibility month is the month you turn 65 or your 25th month of disability benefits if you qualify for Medicare through disability.
- Medicare Advantage and Prescription Drug Plan Annual Election Period (October 15 to December 7): after you’re first eligible, your next chance to make changes is during the Annual Election Period, or Fall Open Enrollment. During this period, you can enroll in a Medicare Advantage plan for the first time, switch plans, or disenroll from your Medicare Advantage plan and go back to Original Medicare. You can also add on stand-alone Medicare prescription drug coverage if you return to Original Medicare.
- Medicare Advantage Open Enrollment Period (January 1 to March 31): during this period, you can disenroll from your Medicare Advantage plan and go back to Original Medicare. You can also, if you return to Original Medicare, enroll in a stand-alone Medicare Prescription Drug Plan. You also can switch Medicare Advantage plans during this period.