Orlando Harmon
Making changes to your Medicare primary insurance can be a straightforward process, but it's important to be aware of the different options and requirements. Firstly, it's essential to distinguish between Original Medicare (Parts A and B) and Medicare Advantage Plans (Part C). With Original Medicare, you typically don't need to choose a primary care doctor, and you can switch providers whenever you want as long as they accept Medicare assignment. On the other hand, Medicare Advantage Plans often require you to select a primary care doctor within their network, and you can only change your plan during specific enrollment periods, such as the Medicare Open Enrollment Period. Additionally, it's crucial to inform your doctor and other healthcare providers about any changes in your insurance coverage to ensure proper billing and avoid delays.
| Characteristics | Values |
|---|---|
| Medicare primary insurance | Original Medicare (Parts A and B) or a Medicare Advantage plan |
| Changing primary insurance | Filling out a change form online or calling member services |
| Medicare Advantage plan | Medicare Advantage HMO (Health Maintenance Organization) plan, Medicare Advantage Preferred Provider Organization (PPO), Medicare Advantage Open Enrollment Period (MA OEP) |
| Medicare Supplement Insurance Plans | Medigap |
| Medicare Advantage Open Enrollment Period | Oct. 15 through Dec. 7 |
| Medicare Open Enrollment Period | Annual Election Period (AEP) |
| Medicare Part A | Hospital Insurance |
| Medicare Part B | Medical Insurance |
| Medicare Part D | Prescription Drug Plan |
| Medicare Advantage | Part C |
| Medicare Advantage plan changes | Only during enrollment periods |
| Medicare with other insurance | Inform doctors and healthcare providers to send bills to the correct payer |
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What You'll Learn
Switching from Medicare Advantage to Original Medicare
- Medicare open enrollment, which runs from October 15 to December 7 and is open to all current and first-time Medicare enrollees.
- Medicare Advantage open enrollment, which runs from January 1 to March 31 and is only open to current MA enrollees.
If you are switching from Medicare Advantage to Original Medicare, you can also purchase a Medicare Supplement plan (Medigap) to help cover your out-of-pocket costs. However, you are not guaranteed eligibility for a Medigap policy if you switch to Original Medicare.
There are three ways to make the switch:
- Visit your local Social Security Office and ask to be disenrolled from Medicare Advantage.
- Call 1-800-MEDICARE (1-800-633-4227) and process your disenrollment over the phone.
- Contact your plan provider directly to disenroll.
If you move away from your Medicare Advantage plan's service area, you can re-enroll in Original Medicare without penalty. This works even if other Medicare Advantage plans are available at your new address. You can switch from a Medicare Advantage plan to Original Medicare the month before you move out of your plan's service area. This opportunity lasts for two full months after the month you move.
Medicare Advantage plans cover your Medicare Part A and Part B benefits plus prescription drugs (Part D) and other health services not included with Original Medicare, such as coverage for dental health, vision, hearing, and gym memberships. Original Medicare only provides Part A (hospital coverage) and Part B (medical coverage).
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Changing your primary care doctor
If you are enrolled in Original Medicare, you can usually switch providers at any time, as long as the new doctor accepts Medicare assignment. It is recommended to call the doctor's office before your appointment to confirm that they accept Medicare. On the other hand, if you have a Medicare Advantage plan, you may be able to choose a different provider within the plan's network or, in some cases, outside of the network.
The process of changing your primary care doctor typically involves filling out a change form online with your insurer or calling member services. It is important to note that your insurer may not cover certain tests, medical therapies, or treatments from a specialist if you do not have a referral from your primary care doctor. Therefore, understanding the rules of your plan about choosing a primary care doctor is crucial to keeping your out-of-pocket costs down.
Additionally, if you have a Medicare Advantage plan and want to switch to a different Medicare Advantage plan or Original Medicare, you can do so during specific enrollment periods. The Medicare Open Enrollment Period, also known as the Annual Election Period (AEP), occurs annually from October 15 to December 7. During this period, any changes made will take effect on January 1 of the following year. Another opportunity to make changes is during the Medicare Advantage Open Enrollment Period (MA OEP), where changes take effect on the first day of the month after the request is received. Outside of these enrollment periods, you may be able to make changes if you qualify for a Special Enrollment Period (SEP), which is typically triggered by certain life events.
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Understanding primary and secondary insurance
Having more than one health insurance plan is not uncommon. Some individuals have a health insurance plan through their employer and another through their spouse, while others may have coverage through their workplace and their own individual health insurance policy. In these cases, one plan is considered primary, and the other is deemed secondary.
When you have both primary and secondary insurance, your primary insurer is billed first and pays its portion according to the policy's coverage limits and rules. Once the primary insurance has paid, the remaining balance or uncovered expenses can be submitted to the secondary insurer for consideration. The secondary insurer then reviews the claim and pays its portion, if applicable. It is important to note that the secondary insurer will only cover expenses that are within its coverage limits and not already covered by the primary insurer.
Determining which insurance plan is primary and which is secondary involves analyzing the specific terms and conditions of each policy. This includes reviewing the coverage limits, deductibles, copayments, and any exclusions or limitations. Generally, the insurance that an individual has through their employer is considered the primary insurance.
Having two health insurance plans can provide benefits, such as reducing out-of-pocket costs and helping to cover expenses that may not be included in a single plan. However, it is important to understand the limitations of both primary and secondary insurance policies to maximize coverage and minimize out-of-pocket expenses. Both types of insurance may have specific coverage limits, exclusions for certain treatments, and high deductibles or copayments.
Changing Your Medicare Primary Insurance
If you are referring to changing your Medicare primary insurance in the context of choosing a primary care doctor, this can typically be done by filling out a change form online with your insurer or calling member services. It is important to note that the process may vary depending on whether you have Original Medicare or a Medicare Advantage plan. With Original Medicare, you generally do not have to choose a primary care doctor, and you may be able to switch Medicare providers anytime, as long as the doctor accepts Medicare assignment. With a Medicare Advantage plan, you usually have to select a primary care doctor within the plan's network.
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Switching from Marketplace to Medicare
To end your Marketplace coverage, update your Marketplace application to reflect the start of your Medicare coverage. You can report a Medicare start date on your application up to three months before it begins. For example, if your Medicare coverage starts on May 1, you can update your Marketplace application as early as February 1, reporting that your Medicare coverage will start on May 1. This will ensure that your Marketplace coverage ends on April 30, the day before Medicare coverage starts.
It's important to note that if you don't end your Marketplace coverage and you received the premium tax credit, you may be required to pay back some or all of that credit when you file your federal taxes. Additionally, if you continue to receive the premium tax credit after becoming eligible for Medicare, you may receive a letter informing you that you need to take action within 30 days, or your coverage will be adjusted based on your Marketplace application.
When switching to Medicare, you have the option to choose between Original Medicare (Part A and Part B) and Medicare Advantage (Part C). Original Medicare typically allows you to switch providers anytime you want, provided the doctor accepts Medicare assignment. On the other hand, Medicare Advantage may require you to select a primary care doctor within the plan's network to oversee your care and refer you to specialists.
Remember, if you have Marketplace coverage in addition to Medicare, you can log into your account at HealthCare.gov or contact the Marketplace Call Center to end your Marketplace coverage. It is important to be vigilant about scams and not share your personal information unless you have initiated the contact.
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Joining a Medicare plan
To join a Medicare health plan, there are several steps you need to take. Firstly, you must meet the eligibility criteria, which include having Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). You must also live in the service area of the plan you want to join and be a US citizen or lawfully present in the US. Additionally, you will need your Medicare Number and your Part A and/or Part B coverage start dates, which can be found on your Medicare card.
It is important to note that you can only join, switch, or leave a Medicare Advantage Plan (Part C), other Medicare health plan, or Medicare drug plan (Part D) during specific times, known as enrollment periods. If you are considering a Medicare Advantage Plan, it is recommended that you first discuss it with your employer, union, or benefits administrator, as enrolling in one might cause you to lose your current coverage.
To find the right plan for you, it is advisable to compare the plans available in your area, considering factors such as cost, services provided, and whether they cover your prescriptions and include the benefits you require. You can use your "Medicare & You" handbook or contact your local State Health Insurance Assistance Program (SHIP) for free personalized health insurance counselling.
Once you have decided on a plan, you can enrol by contacting the plan provider. You can typically do this by phone, through their website, or by requesting and submitting a paper form before the enrollment period ends. Remember to review the rules and guidelines of your chosen plan to ensure you understand the process and any specific requirements.
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Frequently asked questions
Changing to a new primary doctor is typically an easy process of filling out a change form online with your insurer or calling member services. If you are enrolled in Original Medicare, you generally don’t have to choose a primary care doctor. If you have a Medicare Advantage plan, you will have to select a primary care doctor within the plan’s network.
You can make changes to your plan each year during Medicare’s Open Enrollment Period and the Medicare Advantage Open Enrollment Period. The only time you can change your Medicare Advantage plan outside of the usual enrollment periods is if you qualify for a Special Enrollment Period (SEP).
You can switch from an MA plan back to Original Medicare, with the option to join a stand-alone Medicare prescription drug plan (Part D). All changes made during MA OEP start the first day of the following month after the request is received.
Marketplace coverage doesn’t end automatically when Medicare starts. You will have to update your Marketplace application to end Marketplace coverage for those starting Medicare. You can report a Medicare start date on your application up to 3 months before Medicare starts.
