At the beginning of each calendar year, Medicare Advantage (MA) plans can make changes to their benefits, premiums, copayments and geographic service areas. They must notify their members every fall of the changes they intend to make the following year. They can add or drop benefits, change premiums and copayments, and begin or discontinue serving a certain county or region. MA plans must get permission from the Centers for Medicare and Medicaid Services (CMS) before making any changes, and notify their members by early October of changes effective January 1 of the following year.
MA plans are required to provide all Medicare-covered services. They are not required to offer additional benefits, remain in business in certain areas, or continue their contracts with certain doctors or hospitals.
If Your MA Plan Stops Providing Benefits in Your Area
If your MA plan stops providing benefits in your area, you have the right — regardless of age or health condition — to join another MA plan if one is available where you live. Make sure your doctor, the medical group that provides your care and your local hospital are all in the new MA plan network and plan to stay in it. If you find you need to switch doctors, make sure the doctor you choose is taking new patients.
If your MA plan stops providing benefits in your area, you also have the right to return to Original fee-for-service Medicare. If you return to Original Medicare, you have the guaranteed-issue right to buy a standardized Medicare supplement policy, also known as Medigap. Insurance companies must let you buy 1 of 6 standardized Medigap plans — A, B, C, F (with or without the high deductible option), K or L — regardless of your health condition, unless you are younger than 65 and have end-stage renal disease (ESRD).
Because you have a guaranteed-issue right to buy 1 of these 6 Medigap policies, companies selling the policies cannot impose a waiting period before covering your pre-existing health conditions or charge you a higher premium than what is paid by other people your age. Some companies that sell both MA plans and Medigap policies may offer you the right to enroll in their Medigap policy, but if your MA plan stops providing benefits in your area, you may choose any Medigap policy. Learn more about guaranteed-issue periods.
Note: Since the Medicare Part D drug benefit became available in 2006, no Medigap policies sold after January 2006 are permitted to include drug coverage. However, you may purchase drug coverage through a Prescription Drug Plan (PDP). Learn more about prescription drugs.
If Your MA Plan Increases Costs, Drops Benefits or Your Doctor Leaves the Plan
You have the right to switch to a Medigap policy if your MA plan increases the costs you pay by raising or adding copayments. You can also switch to Medigap if your MA plan drops benefits or a medical professional who is treating you leaves the plan. Note: This is not a guaranteed-issue right. The right to switch to a Medigap policy is only available if you buy a policy offered by your MA plan, or any company that is a part of the same corporation as your MA plan. You have 63 days to switch, beginning from the date you are notified of the changes to your plan. If your MA plan/company does not offer a Medigap policy, you do not have this right.
Note: Provider contracts can potentially change at any time. An MA plan must make a "good faith effort" to notify all affected beneficiaries at least 30 calendar days before a provider contract terminates.
See also: additional information for beneficiaries with disabilities, ESRD or employer-sponsored coverage.