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Can a person go from a Medicare Advantage Plan to Original Medicare and a Supplement at any time during the Year? I realize medical underwriting would be a factor.


Answer: Most people cannot switch from their Medicare Advantage Plan HMO or PPO at any time other than the Annual Election Period (AEP) which runs October 15th through December 7th, or the Open Enrollment Period (OEP) which ran January 1st through March 31st in 2019. Be advised it isn’t clear if this election period will be available in 2020 and we’ll discuss that further in today’s column.

Let’s discuss what you can do during AEP and OEP before we get into who can receive an exception to change plans anytime during the year.

Again, AEP runs from October 15th through December 7th and is somewhat of a free for all. You can go from one Advantage Plan to another, from an Advantage Plan to a Supplement, vice versa, or from one Part D prescription plan to another.

I advise everyone who isn’t already a client to contact us as early as October 1st when we have seen all available plans for 2020. We can tell you over the phone in less than two minutes if we believe your current plan is competitive with those we have earmarked as having the best value in 2020 and if an appointment to compare plans is in order. If you already have one of the better plans, we’ll tell you as much and advise you to stay put.

Something not nearly enough people who have Supplements do during AEP is ensure their current Part D Prescription plan is the best for the following year. We evaluate every single one of our Supplement clients’ Part D plans each AEP. It’s shocking how many people can save up to $1,000 or more by moving from one company to another. You see, Part D companies have a pattern of offering low premiums and co-pays for a couple of years, lulling people to sleep so to speak, and then not only increasing premiums and co-pays, but raising the Tiers of drugs from 1 to 2, 2 to 3, or 3 to 4. That can be very costly.

We also send a letter to all our Advantage Plan clients making them aware of any changes in their plan for the following year and advise them to either to stay on their current plan or consider a move to another we feel offers better overall value in terms of the combination of premiums, co-pays, and annual Maximum Out of Pocket (MOOP). Something many people on Advantage Plan HMO’s and PPO’s fail to do is research if their co-pays or MOOP have increased. They often do.

If you’re not currently a client and you would like to receive this letter or have your Part D plan evaluated as if you are a one of our commissioned clients, you can contact us, get put in our database, and be treated just like our active clients during AEP.

OEP was reintroduced this year after a long hiatus and offered a do-over of sorts if you felt a mistake during AEP. It allows you to change from one Advantage Plan to another or go from an Advantage Plan back to Original Medicare and a Supplement. I found the move to reintroduce this Election Period very curious as it was kept a secret. Medicare did not advertise it and agents and brokers like me were not permitted to market it or even make people aware it existed, which I found disappointing because people often get talked into a plan that may not have been best for them.

The only people who can make the change referred to in the question, as well as go from one Advantage Plan to the another, are those who qualify for a Special Election Period (SEP). The most common is having PACENET and the income limits for that program were recently raised. There are several others, and most are income based. However, there are some that aren’t and can be common. Those include being admitted to, or discharged from, a nursing home as well as moving to a new service area, which can be state to state, or even from one part of the state to another. 

I encourage those who don’t qualify for a SEP to contact us prior to October 15th, when there is less pressure to make a decision in the short 53-day window AEP offers. It’s always good to get educated on the differences between Supplements and Advantage Plans, which is the most important piece of information everyone on Medicare needs to have in my opinion.


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Laurel Highlands


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