Before You Drop Your Medicare Advantage Plan, Get Advice From the Right Source
- coralbayins
- Aug 17
- 5 min read
Don't Drop Your Medicare Advantage Plan Based on Social Media Advice! Social media can be a great place to ask for restaurant recommendations, find a handyman or learn what’s happening in the neighborhood. However, it isn’t always the best place to make decisions about your Medicare coverage.
Lately, I’ve seen people advising others to “get rid of” their Medicare Advantage plan and purchase a Medicare Supplement plan instead. That may have worked well for the person giving the advice, but it doesn’t mean it’s the right, or even an available choice for everyone.
Medicare isn’t one-size-fits-all. A decision based on a social media comment could leave someone with higher expenses, no prescription drug coverage or a coverage change they can’t easily reverse.
You generally can’t drop a Medicare Advantage plan whenever you want
Medicare has specific enrollment periods during which you may be able to leave a Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7. During this period, you can change Medicare Advantage plans or return to Original Medicare for coverage beginning January 1.
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31. It’s available only to people already enrolled in a Medicare Advantage plan. During this period, you can make one change by switching to another Medicare Advantage plan or returning to Original Medicare.
A Special Enrollment Period may also be available after certain qualifying events, such as moving outside your plan’s service area, losing other coverage or having your plan terminate its Medicare contract. Outside one of these enrollment opportunities, you usually can’t simply drop your Medicare Advantage plan because someone online recommended it.
Leaving Medicare Advantage doesn’t guarantee that you can get a Medicare Supplement
This is one of the most important details often missing from social media discussions.
Returning to Original Medicare and qualifying for a Medicare Supplement, also called Medigap are two separate issues.
Your six-month Medigap Open Enrollment Period begins when you’re 65 or older and enrolled in Medicare Part B. This is generally a one-time opportunit and it doesn’t return every year.
Outside that period, an insurance company may be allowed to review your health history through medical underwriting. Depending on your health and the rules in your state, the company may charge more, offer fewer choices or deny your application unless you have a guaranteed-issue right.
Certain situations provide special protections. For example, some people have a trial right after trying Medicare Advantage for the first time. However, these protections have specific requirements and deadlines.
Never assume that leaving Medicare Advantage automatically guarantees acceptance into a Medicare Supplement plan. Confirm your eligibility and understand the application process before changing your existing coverage. Medicare explains Medigap enrollment protections here.
Can a Medicare Supplement fit your monthly budget?
Medicare Supplement plans can provide valuable protection from many of the deductibles, copayments and coinsurance left by Original Medicare. However, they also come with a separate monthly premium. Anywhere in the US, a medical doctor accepts Original Medicare your Medicare supplement is available.
Someone choosing this type of coverage may need to budget for:
The monthly Medicare Part B premium
A monthly Medicare Supplement premium
A separate Part D prescription drug plan premium
Dental, vision or hearing coverage, if desired
Costs that aren’t covered by Medicare or the Supplement plan
Medicare Supplement premiums can also increase over time. Before changing coverage, consider whether the monthly premiums will remain manageable not only today, but several years from now. A social media commenter may be financially comfortable paying several monthly premiums. That doesn’t mean the same arrangement will work for someone living on a limited or fixed income.
Why some people prefer Medicare Advantage
Medicare Advantage plans are another way to receive Medicare benefits through a private insurance company approved by Medicare. People still have Medicare, but they receive their Part A and Part B benefits through the plan.
Some people prefer Medicare Advantage because:
Many plans have low or $0 additional monthly premiums, although the Part B premium still applies
Most plans include Part D prescription drug coverage
Plans may include dental, vision, hearing, fitness, transportation or over-the-counter benefits
Medical and prescription coverage may be bundled into one plan
Every Medicare Advantage plan has an annual maximum out-of-pocket limit for covered Part A and Part B services
The tradeoffs may include provider networks, referrals, copayments and prior authorization requirements. Benefits, networks, drug formularies and costs can also change from year to year. For someone who needs to keep monthly premiums lower and whose doctors and prescriptions work well with the plan, Medicare Advantage may be a suitable choice.
Why some people prefer a Medicare Supplement
A Medicare Supplement works alongside Original Medicare. Depending on the plan selected, it can help pay some of the deductibles, copayments and coinsurance that Original Medicare doesn’t pay.
Some people prefer a Medicare Supplement because:
They can generally use any healthcare provider nationwide who accepts Medicare
There are usually fewer network restrictions
Original Medicare generally doesn’t require prior authorization for most covered services
Medical expenses may be more predictable, depending on the Supplement plan
The coverage can be helpful for people who travel or live in more than one state
The tradeoff is usually a higher monthly cost. Medicare Supplements generally don’t include routine dental, vision or hearing benefits, and plans sold today don’t include outpatient prescription drug coverage.
Don’t forget prescription drug coverage
If you leave a Medicare Advantage plan that includes prescription drug coverage and return to Original Medicare, you will usually need to enroll in a separate Part D plan. A Medicare Supplement doesn’t replace Part D. It helps with certain costs associated with Original Medicare, but it doesn’t cover the prescriptions you pick up at the pharmacy.
Even if you don’t take medications today, going 63 days or more without Part D or other creditable prescription coverage could result in a late-enrollment penalty when you enroll later. In most cases, that penalty continues for as long as you have Part D coverage. You can learn more about Medicare Drug coverage here.
Your prescriptions, dosages and preferred pharmacy should be reviewed before choosing a drug plan because every plan has its own formulary, pharmacy network and cost structure.
Good advice begins with questions—not a blanket recommendation
A thoughtful Medicare review should consider:
Your doctors and hospitals
Your prescriptions and preferred pharmacies
Your monthly budget
Your expected healthcare needs
Your travel habits
Your eligibility for a Medicare Supplement
Your tolerance for copayments versus monthly premiums
Any dental, vision, hearing or additional benefit needs
Whether you qualify for Extra Help, Medicaid or a Medicare Savings Program
Someone online may genuinely want to help, but they don’t know your complete medical, financial and coverage situation. Before making a change, speak with a licensed health insurance agent who can help you understand your Medicare choices. You can also contact Medicare at 1-800-MEDICARE or your local State Health Insurance Assistance Program.
The right choice isn’t automatically Medicare Advantage or a Medicare Supplement. It’s the coverage that fits your healthcare needs, financial situation and personal preferences.
If you’re unsure whether your current coverage is still working for you, I’m happy to help you review your Medicare choices. There’s no pressure to change plans simply because another option works well for someone else. You can contact me at (656)228-4979 or email cheryl@coralbayins.com.
By calling this number or providing your information you agree to speak with a licensed insurance agent about Medicare Advantage, Part D Prescription Drug Plans or Medicare Supplements. Not affiliated with any government agency including Medicare.
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