7 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.

According to KFF, a whopping 69 percent of Medicare beneficiaries didn’t compare their current plan to different options during the 2022 AEP. It’s possible your clients are due for a change.

By taking a look at their coverage before each AEP, 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.

Here are some of the reasons your client might need to switch to a new plan.

Reason 1: Their Plan Costs Are Too Expensive

Many factors contribute to the cost of a plan: premium, deductible, copayments, and coinsurance. These costs can change from year to year, creep up, and become too high for some beneficiaries. For example, perhaps your client on a Medicare Supplement can’t handle the monthly premium anymore and is wondering about a Medicare Advantage plan.

AEP is the time to see if your client’s plan is still affordable for them. Considering almost two-thirds of all Medicare Advantage Prescription Drug (MAPD) plans have $0 premiums, chances are pretty good you’ll be able to find a plan that will lower your client’s expenses.

Reason 2: Their Health Needs Changed

With age comes varying changes to the coverage your client needs. A relatively healthy 65-year-old enrollee likely has different needs than an 85-year-old one. Has your client received a new diagnosis? Health status changes necessitate a review of coverage to ensure your client finds the right fit for their unique circumstances.

If they were recently diagnosed with a chronic illness, perhaps a Chronic Special Needs Plan (C-SNP) is more suitable. What about a new drug not covered on their current plan’s formulary? Time to look for prescription coverage that covers all their medications like a new MAPD or Part D plan.

Reason 3: Their Financial Status Changed

If your client hits financial hardship, it may mean they can qualify for Extra Help (Part D low-income subsidy) or a Dual Eligible Special Needs Plan (D-SNP). Likewise, if their financial situation has improved, they may lose eligibility and need to enroll in a different plan. When you review a client’s coverage, remember to tactfully inquire about their financial resources and always check to see if they qualify for Extra Help.

Reason 4: They’re Not Satisfied with the Carrier’s Service

Your client might be dissatisfied with their plan for any number of reasons (besides those already mentioned). Did they have a claim denied? Did they receive a negative annual notice of change (ANOC) on October 14? Did the carrier not pick up the phone? If they’ve had a bad experience with their carrier, your client may be wondering how to change Medicare plans.

It’s important to let them air their grievances. Then, listen and empathize. The plan might offer the most stunning benefits, but without quality customer service to back it up, perhaps it’s time to talk other options.

Reason 5: Their Plan’s Star Rating Changed

The Centers for Medicare & Medicaid Services (CMS) have a Medicare 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.

Because CMS recently reconfigured the way they award star ratings, it’s in your client’s best interest to review their current plan to see if there’s a better-quality option in their area.

Reason 6: Their Doctor Isn’t In-Network Anymore

A doctor (PCP or specialist) becoming out of network can happen because of your client moving or because of carrier or health system changes. If it’s important to your client to keep seeing the same primary care provider or specialist, it might be time to switch plans.

Reason 7: Their Plan No Longer Exists

When your clients receive their ANOC this AEP, they might be surprised to learn that their plan no longer exists, and they’re being transitioned to a new one. There are different reasons as to why a client would be moved to a new plan, including carrier downsizing, restructuring, and legislative measures.

Make yourself available to your clients to discuss their ANOCs and schedule AEP appointments to review current coverage and whether it’s time to switch plans.

AEP is more than a time to enroll your clients in new plans. It’s 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. If their health needs or financial situation has changed, it could be time for a switch to a better fit.

Ritter Insurance Marketing is here to help our agents through change. Explore our resources on upcoming Medicare shifts and register with us to access personalized support and sales technology.