Medicare Advantage Plan Changes to Look For

There can be changes to Medicare Advantage plans that may be implemented from year to year, and it’s important to stay informed about any potential changes that could affect your care. If you are enrolled in a Medicare Advantage plan or are looking for how to sign up for Medicare Advantage, there are five aspects of every plan that could potentially change in the coming year:

1. Costs
2. Coverage/benefits
3. Network providers
4. Medicare plan Star Ratings¹
5. Availability and selection  

Let’s take a detailed look at potential Medicare Advantage plan changes to be aware of each year and what options may be available to you if your plan experiences any changes.

1. Medicare Advantage plan cost fluctuations

Medicare Advantage plan costs are set by the private insurance companies that sell them, which means the plans have the potential to fluctuate in price from year to year.

But that doesn’t necessarily mean that costs will go up every year. In fact, when looking only at Medicare Advantage plans that include prescription drug coverage, the average plan premium actually decreased from $44 per month in 2010 to $36 per month in 2017.²

In addition to plan premiums, other Medicare Advantage plan costs can change each year, such as the amount of deductibles, copayments, coinsurance or out-of-pocket maximums you will be responsible for as a plan beneficiary.

2. Changes in plan coverage and benefits

At the minimum, Medicare Advantage plans are required by law to cover everything that is covered under Medicare Part A and Part B. (One exception is hospice care, which you will still receive under your Part A coverage.) Many Medicare Advantage plans may then offer additional benefits.

Some of the more popular extra benefits include coverage for things like prescription drugs, dental, vision and hearing. Many Medicare Advantage plans may even offer perks like memberships to gyms or wellness programs such as SilverSneakers.

Each year, Medicare Advantage plans may add, drop or change any of these additional benefits, and all extra benefits must be approved federally by Medicare. For 2019, the list of potential new Medicare Advantage benefits could include transportation to medical appointments, home-delivered meals, grab bars in home bathrooms and more. 

Because the selection of additional benefits offered by a Medicare Advantage plan can be different from year to year, it’s important to review any changes to your plan’s coverage each year. 

You may especially want to review your annual plan changes if you have a Medicare Advantage plan that provides coverage for a prescription drug you are taking. Some plans may change their formulary from year to year, and your prescriptions could be affected.

3. Medicare Advantage plan network additions and subtractions

There are several different types of Medicare Advantage plans, including Health Maintenance Organization (HMO) plans and Preferred Provider Organizations (PPO) plans.

With a PPO Medicare Advantage plan, you will generally pay a little more out of pocket when visiting a health care provider outside of the plan’s preferred participating network.

In most cases with an HMO Medicare plan, you are generally required to receive medical care from a provider in the plan’s preferred network, except in the case of emergencies or out-of-area dialysis.

It’s important to remain updated when a provider leaves your given plan network. If your primary care physician leaves your plan network, in many cases you will be required to select a new primary care physician in order to remain enrolled in the plan.

Likewise, it can be just as important to know when a new provider is added to your network, which could give you a new and different option for receiving care. 

Each time you schedule an appointment, confirm that your health care provider is still a participating member of your Medicare Advantage plan network in order to help minimize your out-of-pocket costs.

4. Changes in Medicare Star Ratings

Each year, the Centers for Medicare & Medicaid Services (CMS) releases Star Ratings for Medicare Advantage plans. Plans are rated using a system of one to five stars based on quality, customer service and other metrics.¹

Your plan might experience a change in its Medicare Star Rating from one year to the next. Any change in rating can provide you with an idea of how your plan is performing and whether it may be improving from the year before.

If a plan receives a rating of fewer than three stars for three consecutive years, Medicare will flag the plan as underperforming and notify all beneficiaries. 

Being enrolled in a Medicare Advantage plan that is rated at less than five stars is one way you may qualify for a Special Enrollment Period (see more information about Special Enrollment Periods below).

If you are enrolled in a Medicare Advantage plan that is rated less than five stars, you may enroll in a five-star plan between December 8 and November 30 each year (only if a five-star Medicare Advantage plan is available where you live).

The Star Ratings are updated each fall just prior to the 5-star Special Enrollment Period, so it’s wise to check the ratings each fall to see how your plan measures up.

5. Medicare Advantage plan availability and selection

It’s not just your Medicare Advantage plan’s selection of providers and services that might change from one year to the next. Medicare Advantage plans themselves can even be added or dropped to the selection of available plans in any given area. Two reasons why your choice of plans may differ from one year to the next can include: 

• The insurance companies that sell Medicare Advantage plans contract with Medicare in order to sell the plans. Sometimes, a contract may not be renewed and a Medicare Advantage plan might be dropped from the selection where you live.
 
• The availability of Medicare Advantage plans can vary by location. If you move, you may find yourself outside of your plan’s coverage area, and you may be faced with a different selection of available plans.

Annual notice of change

Fortunately, there is an easy way to stay updated on any of your Medicare Advantage plan changes. Each fall, your Medicare Advantage plan must mail you an Annual Notice of Change (ANOC) explaining any cost, coverage or service area changes that will be going into effect. If you do not receive an Annual Notice of Change by early October, contact your plan to inquire about one.

Fall Medicare Open Enrollment Period

The Fall Medicare Open Enrollment Period lasts from October 15 to December 7 each year. During this period, you can enroll in, drop or switch Medicare Advantage plans, and any changes in your coverage will take effect on January 1. 

The Medicare Open Enrollment Period is a great time to review your Medicare coverage, compare other available plan options where you live and make any necessary changes to your health care coverage.

Medicare Special Enrollment Periods

In addition to the Fall Open Enrollment Period, there are certain situations that may qualify you for a Special Enrollment Period. Just a few of these situations include: 

• Moving to a new address that is not in the coverage area of your current plan
 
• Moving to a new address where new plan options are available
 
• Moving into or out of a long-term care facility
 
• Being released from jail
 
• Losing Medicaid eligibility
 
• Losing employer-sponsored coverage
 
• Your plan terminates its contract with Medicare

Medicare.gov provides information about other events that could qualify you for a Special Enrollment Period.

The start date and length of your Special Enrollment Period will depend on the type of situation that qualifies you for it.

If you ever need help you can always use the Medicare phone number for support!

Get help finding a Medicare Advantage plan

Potential changes to your Medicare Advantage plan can affect your coverage. Contact a licensed insurance agent at 1-800-557-6059 1-800-557-6059 TTY Users: 711 24 hours a day, 7 days a week to learn more about the available plans in your area and find the one that best fits your needs.

¹ Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
² Kaiser Foundation. Medicare Advantage. Oct. 10, 2017. Retrieved from https://www.kff.org/medicare/fact-sheet/medicare-advantage.