Your prescription drug carrier may reach out to offer a plan that changes your medical coverage. Here's what to know before agreeing to switch.
If you have a standalone Medicare prescription drug plan (Part D), you may receive a call or email from your insurance company offering to help you find coverage that better fits your needs. But what sounds like a simple conversation about prescription savings could lead to a much bigger change in your Medicare coverage.
Before agreeing to anything, make sure you understand exactly what is being offered, where to find complete plan information, and how a change could affect your existing benefits.
Are They Trying to Sell You a Medicare Advantage Plan Instead?
Many insurance companies that provide standalone prescription drug plans also offer Medicare Advantage plans (Part C) that may include prescription drug coverage. If your current standalone prescription drug plan is changing, your carrier may contact you about other coverage options, including plans marketed as convenient "all-in-one" solutions.
While these plans may offer benefits worth considering, there is a major difference between switching to another standalone drug plan and enrolling in a Medicare Advantage plan.
With Original Medicare, beneficiaries can receive their Part A and Part B medical benefits directly through Medicare and purchase a separate drug plan for prescription coverage. People who choose this route may also have a Medicare Supplement (Medigap) policy to help cover certain out-of-pocket medical expenses not covered by Original Medicare.
Medicare Advantage, on the other hand, replaces your Medicare Part A and Part B benefits with a network plan offered by a private insurance company.
Have a Medigap Plan? Be Especially Careful
If you currently have Original Medicare, a Medigap policy, and a standalone Part D drug plan, switching to Medicare Advantage deserves careful consideration.
Medigap policies cannot be used to pay Medicare Advantage deductibles, copayments, or coinsurance—So you can’t have both coverages at the same time. More importantly, if you give up your Medigap policy to enroll in Medicare Advantage, you may not be able to get that same coverage back later.
Although certain federal and state protections provide guaranteed-issue rights in specific circumstances, those protections do not apply to everyone. Depending on your situation, returning to a Medigap plan could require medical underwriting or result in fewer available options.
Before giving up your Medigap coverage, understand what you could be losing and whether you would be able to obtain similar coverage again. If freedom of choice is something you value with your Medigap plan, changing to a Medicare Advantage plan can bring you network restrictions.
Skipping the Call and Shopping Online? Medicare.gov May Not Show Everything You Need to Know
If you prefer to shop for drug coverage online, Medicare.gov is a valuable starting point for comparing plans, reviewing estimated costs, and enrolling in coverage. However, you should understand that the information displayed through Medicare's Plan Finder may not provide every detail needed to evaluate a plan.
Important documents, such as a plan's Summary of Benefits (SOB) and Evidence of Coverage (EOC), may require additional steps to locate or review.
These documents explain important coverage details, including cost-sharing requirements, covered services, and plan restrictions that may not be immediately apparent when comparing options online. You may need to visit the insurance carrier's website or contact the carrier directly to obtain complete documents and answers to specific coverage questions.
You can still enroll through Medicare.gov, but being able to enroll in a plan does not mean you have reviewed everything you need to know about that plan. Before making a change, take the time to get all the information you need to make an informed decision.
Ask The Right Questions—The First Time
Reviewing coverage options requires more than comparing monthly premiums or advertised benefits. If you decide you want to change plans, be sure to ask the right questions.
Some important questions to ask before you switch your plan:
- Prescription drugs: Are your medications covered, and what will you pay at your preferred pharmacy?
- Doctors and hospitals: Will your current healthcare providers accept the plan, and are they in-network when required?
- Medical expenses: What are the deductibles, copayments, coinsurance, and maximum out-of-pocket costs?
- Prior authorization: Will certain medical procedures, services, or prescriptions require advance approval?
- Coverage restrictions: Are there referral requirements, network limitations, or other rules that could affect your care?
Even plans offered by the same insurance company can have different benefits, costs, and coverage requirements. Taking the time to review these details can help you avoid unexpected expenses or disruptions in care.
When to Call Your AMAC Medicare Advisor
While contacting insurance carriers directly is helpful for obtaining detailed plan information, your AMAC Medicare advisor should be the first person you call. Not only does your AMAC advisor have all that information readily available, but they can help you understand what it means.
If you want to review your current Medicare Supplement plan, we can help you evaluate your coverage, explore available alternatives, and understand whether making a change makes sense for your needs.
If you are considering switching to a Medicare Advantage plan, we can help explain the differences between your current coverage and the proposed plan, including potential effects on your medical benefits, prescription drug coverage, and Medigap policy.
The goal is not simply to find a plan with a low premium. It is to understand how that plan would work for you when you need medical care.
Don't Get Pressured to Decide During a Sales Call
Receiving a call from your insurance company does not mean you need to make a change. Medicare has rules governing how insurance companies and agents can market plans to beneficiaries.
Agents cannot pressure you to join a plan by claiming you will lose coverage if you do not enroll. They also cannot ask you to sign an enrollment form before you are ready. If you receive an unexpected offer, request the information in writing and take time to review it.
Remember that Medicare's Annual Enrollment Period (AEP) runs from October 15 through December 7 each year, with changes generally taking effect January 1. Other enrollment opportunities may be available depending on individual circumstances. There is no need to make an immediate decision during an unexpected sales call.
Protect Your Medicare Coverage Before Making a Change
Your Medicare coverage affects far more than your monthly premium. It can determine which doctors you see, which prescriptions are covered, how much you pay for medical services, and what options remain available in the future. If your prescription drug carrier contacts you about another plan, make sure you know whether the offer involves prescription coverage alone or a change to your medical benefits.
If you are considering changing your Medicare Supplement plan or moving to Medicare Advantage, contact your AMAC licensed insurance advisor before authorizing a change. An informed decision today can help protect your healthcare choices tomorrow.
For help with Medicare plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or request a call at amac.us/medicare.
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