A new CA Medicare Advantage rule says if your plan raises costs, limits doctors, or reduces benefits, you pick up a Medigap plan without answering medical questions. It’s out in California now, but it might be available in other states.
What are Medicare Advantage Plans?
Medicare Advantage Plans are just another way to get your Part A and Part B coverage. These plans, sometimes called Part C or MA Plans, are approved by Medicare but run by private companies. A lot of the time, they also include drug coverage (Part D). Keep in mind that most plans require you to use doctors and hospitals in their network, but some may cover out-of-network care at a higher cost. Plus, for certain treatments or medications, you might need to get approval from your plan or get a referral to see a specialist. If you need extra info, you can check our “Medicare Advantage Overview” article.
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Medicare Advantage Price Increase or Doctor/Benefit Decrease Switch
If you’re in California and your Medicare Advantage plan raises premiums, increases copays, or stops working with your doctor, you can switch to a Medigap plan from that same company. If they don’t offer Medigap, you’re free to choose any Medigap provider in California. Also, some only allow these changes during the Annual Election Period (Oct 15 – Dec 7), while others don’t. Call us for the latest details.
What are the requirements to switch Medicare Advantage under this new rule?
According to one of the leading insurance companies in California, you may be able to switch if you are currently enrolled in a Medicare Advantage Plan and one of the following happens:
- The plan cuts back on benefits, meaning you would have less coverage than before.
- If the plan raises your cost-sharing amounts or premiums, increasing your overall healthcare costs.
- The plan decides to discontinue its contract with a provider you’re using for services, unless it’s for quality-of-care reasons.
- Also, if your current Medicare Advantage insurer or its parent company doesn’t provide Medicare Supplement plans, you would be eligible to switch to one of those options instead.
Even if you don’t qualify, don’t give up! Our “Medicare Insurance Switching: Ultimate Guide” has all the info you need. Learn about all your options.
How to know if your MA plan has Changed to Qualify for this rule?
ANoC! That stands for Annual Notice of Change. Every Medicare Advantage plan MUST send you this document each year. It will tell you if they have made any changes to benefits, networks or pricing. It usually arrives in October each year.
If you cannot find your ANoC, give us a call at 800-930-7956 and we can often look it up for you.
How does this Medicare Advantage Switching Rule work?
If you notice a qualifying change on your ANOC, you can choose from Plan A, F Extra (will ONLY be available to those who turned 65 prior to January 1, 2020), Plan G, G Extra, or Plan N. Typically you should apply during the Annual Election Period (AEP) unless if your Medicare Advantage plan stops working with your provider.
Make sure to complete the Current Insurance Coverage section of your Medigap application, including the end date. Once approved, you can cancel your Medicare Advantage plan. To help speed up the process, attach the ANOC (annual notice of changes) letter and, if applicable, a termination letter from your provider.
We get it, there’s a lot to digest. If you need a helping hand, our team at Senior65.com is here for you. Just call us at 800-930-7956 or leave a comment below. There are no extra fees and we’re here to help.
Do the new Medicare Advantage rules apply to my state?
Unfortunately, we can’t say for sure which other states use this rule. Still, KFF Health News reports that a few companies have applied it in other areas across the country over the years. “After insurers dropped hundreds of providers in 2013, the Centers for Medicare and Medicaid Services (CMS) issued rules giving people a “special enrollment period” to change plans or join regular Medicare if there was a “significant” change in their provider network. Medicare officials have quietly granted the special enrollment periods to more than 15,000 Medicare Advantage members in seven states, the District of Columbia and Puerto Rico based on provider cuts.” (Source: KFF Health News)
So, to our knowledge, this rule is available right now only in California, though it could apply in other states. Want to see if it can help you? Our Senior65.com experts are here to chat for free. Give us a call at 800-930-7956.