Top ten questions about enrolling in a 2024 Medicare Part D plan, Medicare Advantage plan, or Medicare Supplement.
(1) Question: How do I change my Medicare Part D or
Medicare Advantage plan?
You simply enroll in your selected 2024 Medicare plan. Your current 2023 Medicare plan will be
automatically notified about your plan change. As noted in the last Newsletter,
you can
enroll into a 2024 Medicare Part D or
Medicare Advantage plan by: (1) calling a Medicare representative at
1-800-Medicare, (2) visiting the Medicare.gov website, (3) contacting a local
SHIP volunteer, (4) working with a local insurance agent
representing your chosen plan, or (5) telephoning a Medicare plan Member
Services or Customer Services representative.
(2) Question: Can I join a Medicare
drug plan if I have VA drug coverage?
Yes. If you currently receive your
prescription drug coverage through the Veterans Administration (VA), you have the
option to also join a stand-alone Medicare prescription drug plan (PDP) or Medicare
Advantage plan with drug coverage (MAPD).
You can then use either your VA drug benefit or Medicare drug coverage to purchase
your medications – whichever is more economical or convenient. However, you
cannot use your VA drug benefit
together with your Medicare drug plan to pay for the
same prescription. You can read more in our Frequently Asked Question
(FAQ) about
VA benefits and Part D coverage.
(3) Question: Can I join a stand-alone
Medicare Part D prescription drug plan if I have employer coverage?
Probably not. Most people cannot enroll
in both an employer health plan that includes prescription coverage and a separate
Medicare Part D prescription drug plan. If
you have prescription coverage through your employer health plan, and you enroll
in a Medicare Part D plan (
PDP), you
risk losing your employer health coverage. You can
click here to read more.
Important: Ask before enrolling. Before enrolling in a Medicare prescription drug
plan, be sure to contact your employer health plan administrator for further information
or you may be without 2024 healthcare coverage. You can
click here to see more FAQs about Medicare
plans and your employer coverage.
(4) Question: Can I join a stand-alone
Medicare Part D drug plan if I have a Medicare Advantage (MA) plan that does not
have drug coverage?
Yes, but only if . . . You can add separate
Medicare rug coverage to a Medicare Advantage plan – but only if you have a Medicare
Advantage Private-Fee-For-Service (
PFFS) plan
that does not include prescription coverage, a
Cost plan, or
a Medicare Medical Savings Account (
MSA) plan. Remember, there are only
a limited number of
2024 Medicare Advantage PFFS plans, Cost plans, and MSA plans available.
Important: You cannot add a
separate Medicare prescription drug plan if you have a Medicare Advantage
HMO or
PPO plan
that does not provide drug coverage (
MA). In fact, enrolling in a “stand-alone” Medicare
Part D drug plan (
PDP), when
you are already enrolled in an HMO or PPO, will automatically disenroll you from
your Medicare Advantage HMO or PPO plan.
You can click here to read more.
(5) Question: Can anyone
enroll in a Medicare Advantage Special Needs Plan?
No. Medicare Advantage
Special Needs Plans
(SNPs) are designed to provide a balance of benefits that meet the needs of a
particular group of Medicare beneficiaries – such as people who are
institutionalized (I-SNP) or have limited financial resources (dually eligible Medicare/Medicaid,
D-SNP) or have a specific chronic condition (like diabetes or heart disease,
C-SNP). If you wish to join a SNP, you
will be required to show evidence that you meet the eligibility requirements of
the plan – such as economic need or a specific chronic condition.
(6) Question: Can I join any
Medicare drug plan if I qualify for the Medicare Part D Low-Income Subsidy?
Yes. If you qualify for the
Medicare Part D
Low-Income Subsidy
(LIS) or Extra Help program, you can join any Medicare Part D or Medicare
Advantage plan in your Service Area (state or ZIP code area).
However, you will only qualify for the $0 monthly premium if your
Medicare drug plan qualifies for your state’s
$0 LIS Benchmark premium –
unless,
you enroll into a Medicare Part D plan or Medicare Advantage plan that already
offers a $0 premium – such as the
2024 Florida
WellCare Value Script plan or the 2024 AARP Medicare Advantage (HMO-POS) plan found
in
Los Angeles.
(7) Question: Can I join a stand-alone Medicare
Part D drug plan if I have a Medicare Supplement?
Yes. You can enroll in a Medicare Supplement
and join a separate Medicare Part D plan (PDP). You can
click here to read more about
adding a PDP to a Medicare Supplement plan. And you can
click here to review the
stand-alone Medicare Part D plan options in your area.
(8) Question: Can I join a Medicare
Advantage (MA or MAPD) plan if I have a Medicare Supplement?
Surprisingly, yes. But you can
no longer use your Medicare Supplement when you join a Medicare Advantage plan. Although you are permitted to join a Medicare
Advantage plan when already enrolled in a Medicare Supplement, your Medicare Supplement
will no longer provide any healthcare coverage benefits.
Click here to read more…
(9) Question: Can anyone who is Medicare
eligible join a Medicare Supplement?
Yes – when you are initially eligible for Medicare (turn 65). Although Medicare Supplement rules vary by
state, in general you will have a “guaranteed issue” right to join any Medicare
Supplement when you first become eligible for Medicare. After your 6-month Medigap Open Enrollment Period,
you may be subject to medical underwriting, pay a higher premium, or be denied coverage.
Important: Some states have
more generous enrollment rules allowing people to join or change Medigap policies
outside of their initial Open Enrollment Period and still have a guaranteed issue
right. For more information, you can contact
a local insurance agent or
SHIP volunteer
and ask about your rights to join a Medicare Supplement. You can
click here for an overview of
the benefits offered by different Medigap policies.
A note to under-65 Medicare beneficiaries: If you are an under-65 Medicare beneficiary due
to a disability or ESRD, your right to join a Medicare Supplement will depend on
the state where you live. The Centers for
Medicare and Medicaid Services (CMS) currently shows
33 states giving under-65 Medicare
beneficiaries the right to join at least one type of Medigap policy – with insurance
companies in other states voluntarily allowing Medicare beneficiaries under 65 to
join their Medicare Supplement plans. However,
no matter where you live, once you turn 65, you can participate in the Medigap Open
Enrollment Period and have the same guaranteed-issue right to join any Medigap policy
available within your state.
(10) Question: Are there many
differences between a Medicare Supplement and a Medicare Advantage plan?
Yes. A few key differences are:
What the plan covers
A Medicare Supplement (Medigap policy) works with your Original Medicare
Part A and Medicare Part B – filling “gaps” in Medicare coverage. A Medicare Advantage plan administers your
Medicare Part A and Medicare Part B benefits and must provide coverage that is
at least as good as Original Medicare – may include prescription drug coverage
and also offer additional health-related and non-health-related
supplemental benefits.
Term of Coverage
A Medicare Supplement continues unchanged from year-to-year and may raise
premiums over time. A Medicare Advantage
plan is only for a single calendar year and
can change coverage
features and premiums each year. Medicare Advantage plan members will be automatically re-enrolled each
year unless they actively choose another plan or the plan
does not renew its
contract with Medicare.
Guaranteed Issue and Renewal Rights
After your 6-month initial Medigap Open Enrollment Period with guaranteed
issue rights, you can enroll in a Medicare Supplement at any time, but
depending on your state, you may be subject to medical underwriting, pay a
higher premium, or have your Medigap enrollment denied based on your health.
Medicare Advantage plans are always guaranteed issue without any health
questions – with the exception that, as noted above, chronic illness
Special Needs Plans
(C-SNPs) can confirm your health-related condition with an enrollment question
such as: “Do you have one of the following conditions: Cardiovascular Disorder,
Diabetes, Chronic Heart Failure?”
Healthcare Provider Access
Medicare Supplements do not have a fixed network of healthcare providers and in
most cases, plan members can visit any healthcare provider that participates in
Medicare. Medigap policies are very
portable for domestic travelers – and may include some coverage for
international travel. Medicare Advantage
plans
often have a fixed network of
doctors and hospitals with higher costs and possible restrictions for people
who are seeking benefits outside of a plan’s healthcare network.
Click here for more examples of
how Medicare Advantage plans differ from Medicare Supplements.
Related Article:
Example of choosing between a
Medicare Advantage plan and a Medicare Supplement.
Bottom Line: Do not confuse Medicare Advantage plans with
Medicare Supplements. When in doubt,
telephone a Medicare representative at 1-800-633-4227 or contact a local
SHIP
volunteer for assistance.