If you’re enrolled in a Medicare Advantage Plan, every year before the Annual Election Period, you may be concerned about changes to your plan. Medicare Advantage changes may be the result of your plan provider changing benefits to adjust for market conditions or making plans more attractive.
Medicare Advantage changes vs Medicare Advantage Plan changes
Medicare Advantage Changes
Changes to your plan can happen two different ways: There can be overall changes to the Medicare Advantage program or their can be changes to your individual plan, initiated by the plan sponsor.
Changes to the Medicare Advantage program can come in the form of funding cuts or general guidelines about how the program should work. Another factor that may have an impact on your plan is the requirement that sponsors of both Medicare Advantage and Medicare Part D Plans must meet a medical loss ratio of 85%.
What this means is that 85% of revenue must be used for member benefits. The remaining 15% can be in the form of administrative costs and profit. How the medical loss ratio will affect your benefits is yet to be seen.
Reimbursement to medical providers could have a major impact on where you will be able to use your plan. Providers are not obligated to remain in a provider network and generally enter a one year contract, corresponding with the calendar year.
Medicare Advantage Plan Changes
Medicare Advantage Plans are good for one calendar year. Each year in September, plan sponsors are required to mail an Annual Notice of Change / Evidence of Coverage document. Any changes to your plan will be detailed in this notice.
There can be changes to:
- A Plan’s monthly premium
- Plan Benefits (including Part D benefits)
- Cost sharing amounts (copayments, coinsurance and deductibles)
- The provider network
It’s also possible that your Medicare Advantage Plan will not renew. If this is the case you will be entitled to a Special Enrollment Period allowing you a little extra time to find a new plan.
When you consider possible changes to your Medicare Advantage Plan focus on those things you can control. Control starts when you compare Medicare Advantage Plans each year. You can return to original Medicare or return to original Medicare and purchase a Medicare supplement if no Advantage Plans are suitable.