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Health care consumers whose Medicare Advantage plan isn’t panning out as advertised have an out — Uncle Sam has your back.

From January 1 to March 31, Medicare Advantage customers can change plans if the recipient doesn’t like the plan. Consumers can either choose a new Medicare Advantage plan or switch back to a traditional Medicare (Part A or Part B) plan, even after they originally enrolled in a plan during the Medicare open enrollment period from October 15 to December 7, 2018.

Medicare experts are calling the policy a “do over” early in the year, in the event a specific Medicare Advantage plan isn’t meeting a health care consumer’s needs. The caveat is this — if you do move to a new plan, make sure it’s the one that works best for you, as you only get one bite of that do-over apple.

More time to think about Medicare plans

Having the option to change Medicare Advantage plans is a new wrinkle for health insurance consumers. From 2011 to 2018, Americans had no option to change horses midstream from one Medicare Advantage plan to another, aside from the autumn open enrollment period, unless extenuating circumstances approved by Medicare.

“The new policy means that consumers have time to digest their Medicare Advantage plan and now have the ability within the first three months of the new year to determine if this plan is right for them,” says Sandy Swartz, a health care consultant based in Hastings, Michigan. “Many times, patients don’t realize or don’t understand what their policy will really cover until after they start using it.”

That’s especially the case during the enrollment period when Medicare consumers are bombarded with information from insurance companies.

“There are so many options within those companies that it’s very hard for them to understand what type of coverage they will need in the next year,” Swartz says. “Many times, the consumer doesn’t realize what’s going on until after the plan takes effect and they go to their doctor or you pick up your prescription. Then they determine the plan doesn’t work for them.”

Reasons to switch Medicare Advantage plans

Medicare Advantage customers who switch plans likely do so for several reasons — notably because their prescription medicine is not on the Medicare Advantage plan they chose, or their physician and pharmacy are outside of the plan’s network.

“Medicare is a complex program, and not all the rules are easy to find and understand,” says Nina Simmons, marketing director at MedicareHealthPlans.com. “Folks switching from Original Medicare to Medicare Advantage especially may not realize just how different coverage could be.” 

Additionally, different insurers cover different drugs, for example, and some companies may have additional barriers to getting covered medications. “Imagine trying to run a quick errand to fill a prescription and finding out you have to try another drug first or request an exemption, even though you’ve been on the medication for years and haven’t switched doctors,” Simmons notes. “That’s a rough introduction to a new plan, but it’s a common experience.”

Thus, the need for an extended deadline to switch from plan to plan.

“The new Medicare Advantage Disenrollment Period is like a 'cooling off period' and can help folks avoid buyer’s remorse,” Simmons adds. “Instead of getting stuck in the wrong plan for a year, they could switch plans and have their new benefits kick in within a month.”

Even Medicare Advantage customers who turn to a seasoned customer service representative for help in choosing a plan during the open enrollment period may need a change of plan.

“Medicare and insurance coverage is vast and ever changing,” Swartz says. “In many instances, the representative handling your application is unaware of all of the stipulations covering a particular policy, so Medicare offers this service so that you are not roped into a particular policy for an entire year that is not serving your needs.”

Swartz cites a particular Medicare Advantage plan customer who was quoted a prescription drug plan and was told all of his medications were covered with no deductible and a very low co-pay. 

“The customer decided to go with this plan,” she notes. “But when the plan took effect in January, he discovered that this particular plan changed the tiers where his drugs had belonged and were no longer covered.

“If he remained in the plan, his prescription costs would have been over $400 per month,” she adds. “In this case, he was able to switch insurance carriers to one that was more cost effective for him.”

Limitations of Medicare

The Medicare Advantage “do over” is a solution to an age-old problem for customer service plans, Medicare-related or not, other experts say.

“People are not always 100 percent completely aware of the plan they joined,” says Randy Frey, vice president of senior services at FNA Insurance Services, Inc. “Many are not aware that they now have a network of Medical providers that they must use. They may not be aware that they are only covered for emergencies or urgent care. These are typically the nuances that are either not very well explained or not well understood at the point of enrollment.”

Frey, who has spent over two decades studying Medicare, says that in many cases people only realize the limitations of their plan once they use it.

“They may contact the doctor that they have had a relationship with for years only to find out that they can no longer see that provider as he or she does not participate in the plan the member choose.”