Dear AMAC,
I know the annual enrollment period has ended, but I just found out my doctor is no longer in network for my current plan and my drug copays have become too expensive. I’m just not happy with my Advantage plan and I fear that I will have to keep this for another year. Do I have any way out or am I stuck?
-Pamela (Salt Lake City, UT)
Hello Pamela,
I’m glad I came across your question. Since Medicare rules can be confusing, Medicare beneficiaries are often unaware of all their options. I know that you feel trapped in your Medicare Advantage Plan, but the good news is that you do have an opportunity to change it!
The Medicare Advantage Open Enrollment Period, or MA OEP, is happening right now. You may not have heard about it because there are strict Medicare regulations prohibiting agents from proactively offering this enrollment period to you. This means that unless you let your agent know you are unhappy with your plan, they may not be able to help you change it.
The Medicare Advantage Open Enrollment Period runs from January 1st to March 31st of each year (not to be confused with the Annual Enrollment Period that happens each fall).
There are a few important points to remember about the MA OEP:
- This is an enrollment period only available to those who ALREADY have a Medicare Advantage Plan (regardless of whether it includes drug coverage).
- During this time, if a Medicare Advantage enrollee is dissatisfied with their plan, they can make a 1-time change to their coverage.
What kind of changes can be made during the MA OEP?
- You can enroll into a different Medicare Advantage plan (with or without drug coverage)
- You can drop your Medicare Advantage plan completely and go back to Original Medicare.
- You can enroll into a Stand-Alone Prescription Drug Plan (PDP)
If you choose to make a change during this time, your new plan selection will begin on the 1st of the following month. Keep in mind that making a change during the MA OEP does NOT guarantee acceptance into a Medicare Supplement (Medigap) plan.
Thank you for taking the time to write us, Pamela. If you would like further assistance from one of our licensed Medicare Advisors, please give us a call at 855-611-4856.
-Your Medicare Advisor
For help with Medicare plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or request a quote below!
I very foolishly joined an advantage plan (Humana) and was hit hard 3 times in the 1st 10 days by 3 costly appointments that were not covered tho I asked specifically about these doctors and a very expensive ($600) prescription. I tried to cancel and was told I was under contract and could not cancel. I had never signed a contract and was not about to. I called Medicare, explained everything and Medicare overroad the Advantage plan! I will never consider another one. One rotten apple spoils the whole buschel. I was very thankful Medicare took care of the problem for me. 30 days on Humana Advantage cured me! But I have friends and family who use other Advantage plans who have had all kinds of problems. If it sounds too good to be true, it probably is!
no one and I mean no one tells us about the benefits of Supplemental. Remember that word.
Supplemental which is referred to here by some as medigap. Advantage gets 95 % of the attention because its free….free…free BUT pays only 80% of your doctors surgery bill while Supplemental
pays 100%. Supplemental charges a monthly fee. Lets be clear about that but it can save you
tens of thousands of dollars when you have surgery. ASK…..ASK about it or no one will tell you
Good Morning,
That is a great point; while Medicare Advantage plans are heavily advertised, it is important to ask your insurance advisor about all options available. Medicare Supplement plans (Medigap) have different levels of coverage, so it is a good idea to ask your advisor to go over more than just one plan.
Thank you for your comment!
What I have noticed with original Medicare, if you have any medical condition and you want to switch carriers it is almost impossible to change, They put you thru a big questionnaire and then the new company does a review and if you have major health problems you will never switch carriers . We were turned down and second year we didn’t even try to switch knowing it would only get turned down. If you change to an advantage plan you will never go back to original Medicare if you have major health conditions. I laugh at the ads that say you can switch plans anytime! Not if you have medical problems which then pushes up the price of your insurance.
Hello Maire,
When it comes to Medigap plans, most people will be medically underwritten unless they qualify to bypass underwriting.
However, underwriting questions change every now and then, so it doesn’t hurt to check periodically to see if you can change your Medigap policy. A condition that previously disqualified you in the past may not be a deal breaker now if the carriers’ questions have changed.
Please give one of our licensed insurance adviors a call at 1-855-611-4856 if you would like to discuss the Medigap plans we offer in your area.
Have a wonderful day!
I never signed up due to limited MD choices if warranted or your MD may NOT take
Otherwise sounds great
Hello Stephen,
You are right, there are very few Medicare Advantage Plan options offered in your state. That is definitely something to consider when choosing this type of plan. Thank you for bringing up this excellent point!
I want to know how doctors can refuse the normal Medicare health care program. I’m new to FL, have called at least 5 doctors and ALL of them said they don’t accept Medicare patients but do accept Medicare advantage plans. I thought Medicare was supposed to be the premium US health care program and doctors “refuse” those people? How can they do that?
BTW: i also have a very well known supplement health care plan to back up my Medicare. By refusing Medicare patients, the doctors force people to take Medicare Advantage plan.
Hello Ann,
When scheduling an appointment, many times the receptionist does not have proper knowledge of Medigap plans, and as a result you are wrongfully turned away. I have come accross this scenario many times and it’s unfortunate that people are delayed access to care because of it.
Please be sure to mention that you have Original Medicare AND a Medicare Supplement plan (Medigap) because you should be able to see any doctor that accepts Original Medicare- Medigaps do NOT have a network.
I hope you are able to get in soon to get the care you need!
Sabrinah, would you clarify your response regarding a doctor accepting or not accepting assignment from Medicare for both Original Medicare patients and Medicare Advantage patients ?
If a doctor accepts assignment from Medicare, doesn’t that mean that the doctor will accept what Medicare determines to be the allowed amount as payment in full of the doctor’s bill regardless of whether the patient has Original Medicare or a Medicare Advantage plan ?
Once a doctor agrees to accept assignment from Medicare, doesn’t that acceptance apply equally to Original Medicare patients as well as to Medicare Advantage patients ?
Hello Dan,
You are correct! If a doctor accepts Medicare assignment, that means they have already agreed to Medicare’s pre-negociated payment for services rendered, regardless of whether the patient has Original Medicare or a Medicare Advantage plan.
It is important to know that a doctor may still agree to see Medicare patients, but not accept Medicare assignment.
In this situation, your provider may use your insurance as a partial payment and bill you up to 15% more than the Medicare allowable rate (this is known as an Excess Charge).
The good news is that 98% of physicians accept Medicare assignment, and some states have banned Excess Charges all together. You can avoid these charges by simply asking if your provider accepts Medicare assignment.
Thank you for your question!
My question is how do we stop this criminal treasonous fool from destroying our country.
I guess that no one has paid attention that Biden is PUSHING TO CANCEL MEDICARE ADVANTAGE PLANS after stating in his SOTU speech that he wouldn’t do this!! The money he will save doing this will then go to the ILLEGAL IMMIGRANTS and Foreign Countries like China and other nations not part of NATO.