5 Reasons Clients Switch Medicare Plans During AEP

With the Medicare Annual Enrollment Period (AEP) just around the corner, you should encourage your clients to review their Medicare coverage, and in some cases, help them switch to a different plan.

Around 10 percent of Medicare Advantage enrollees switch plans year to year, and it’s possible your clients are due for a change. By taking a look at their coverage before each AEP, the time each year when consumers can freely switch Medicare plans, your clients can not only save themselves money in the event that they would like a change, but also check in to see if their current plan is still working for their lifestyle and budget.

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There are a few reasons — and ways — to switch Medicare coverage, as well as reasons to stay put.

Cost of Coverage

Is your client’s plan still affordable for them? Are they missing out on a lower premium for the same coverage? Help your clients compare plans (and enroll) with Shop & Enroll. You can select up to three different plans to compare and select the product that offers up the coverage and cost that makes sense for them.

Some questions your clients should consider concerning the cost of a Medicare Advantage plan are:

  • Does the plan they’re considering/currently enrolled in charge a monthly premium in addition to their Part B premium?
  • How much will they/do they pay in copays in- and out-of-network?
  • Does the plan have an annual deductible?
  • What’s the maximum out-of-pocket limit?
  • Are there any network restrictions?
  • Are your client’s preferred physicians in their current network or the network of the plan they’re considering?
  • Do they have a prescription drug plan, and if they do, are their current prescriptions covered?
  • Are there any other benefits to the plan they currently have that they’d be giving up with another?

It may also be beneficial for your client to keep in mind future needs that may come up that, while it would cost them more now, would need to be covered by a more inclusive plan.

Changing Needs

With age comes varying changes to the coverage your client needs. Here are the switches consumers can make during AEP that may help with fluctuating health care needs.

  • Change to/from a Medicare Advantage plan to/from Original Medicare (Parts A and B)
    • Purchase a Medicare Supplement to pair with Original Medicare
  • Switch from one MA plan to another
  • Enroll in a Part D plan
  • Switch from one Part D plan to another
  • Drop a prescription drug plan altogether

Note: These changes can also be made during a Special Election Period (SEP), but those are only offered in specific scenarios, and the dates and length of an SEP are determined based on a beneficiary’s situation. By reviewing and making proper changes during AEP, your clients have the potential to save themselves time and money.

Plan Changes

Of the one in 10 enrollees who switched their MA plan in 2014, those who’d seen a higher increase in their premium from year to year were found more apt to do so. Twenty-nine percent of those who switched saw an increase of $40 or more in their premium.

Your clients may also be looking for a bigger network in their area, especially if theirs will shrink in the upcoming year. In 2015, more than 35 percent of MA beneficiaries had plans with “narrow networks” encompassing less than 30 percent of physicians in their county.

Change in Eligibility

To be eligible to enroll in Medicare Advantage, your clients must be enrolled in Medicare Parts A and B as well as live in the service area of their MA plan. End-stage renal disease will also result in ineligibility in most cases, though there are exceptions. Have any of these qualifiers changed for your client?

On the other hand, your client may only become eligible for Medicare in the coming year. AEP is a great time to go over the process of applying for Medicare, and whether or not they’ll be automatically enrolled.

Star Ratings

The Centers for Medicare & Medicaid Services have a star rating system in place to help beneficiaries discern where their current plan falls on the scale out of five stars. This annual checkup may reveal that they’re not receiving the highest quality coverage available.

The ratings system is based on the following:

  • Whether members got their check-ups (screenings, vaccines, etc.) to keep themselves healthy
  • How often members with chronic conditions received the recommended tests and treatments to manage their health
  • The overall experience a member has with a plan
  • How often Medicare experienced problems with a plan, and how many complaints members have made about a plan
  • Health and drug plan customer service
  • How accurate a plan’s pricing information has been and the safety of its drug recommendations

While 66 percent of beneficiaries were in four-star plans as of 2017, it’s still within your clients’ best interest to review their current plan to see if there’s a better quality option in their area.

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AEP is more than a time to enroll your clients in new plans, it’s a time to check in on your clients’ changing needs and consider whether their plan is the right option to manage their health for the next 12 months.

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