You might not have to wait to change your Medicare plan | Opinion

·3 min read

Buyer’s remorse may not matter much when you aren’t happy with a new toothpaste or dinner recipe, but when it comes to medical care, the wrong decision could impact your health and your wallet.

Medicare-eligible individuals who have realized their current plan doesn’t meet their health needs may not have to wait until the annual election period — which begins Oct. 15 — to make a change.

Understanding the options you have during the special enrollment periods for plans with certain quality ratings or after specific life events could mean beneficial changes to your care options sooner than you think. For the Medicare-eligible individuals in Tennessee who need to predict their health care needs, this is especially important to know.  

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Medicare Advantage plans often end up being costlier than Original Medicare plans.
Medicare Advantage plans often end up being costlier than Original Medicare plans.

Special enrollment periods are an option under certain circumstances outside the standard enrollment timeframe:

  • 5-star Medicare Advantage plans: A 5-star rating is the highest possible rating from the Centers for Medicare & Medicaid Services (CMS) and is determined by input from member-satisfaction surveys, health plans and health care providers. You can switch to these plans one time per year if they are available in your area.  

  • New residence: If you recently moved to a new address that isn’t in your current plan’s service area, there may be new plan options in your new location. Also, if you relocated from a long-term care facility, you may be eligible to change your plan mid-year.

  • Lost current coverage: If you are no longer eligible for Medicaid, you left coverage from your employer, or your prescription drug coverage is no longer considered “credible,” you may be eligible to switch to a new plan.

It’s possible the plan you selected last year may not be ideal for your current health needs or provide supplemental plan benefits, such as transportation services to and from doctors’ appointments.

Doug Haaland
Doug Haaland

If that’s the case, knowing your options could help you determine if it is possible to change to a different Medicare Advantage plan mid-year to better meet your needs. Making an informed choice on a health plan is critical since health needs can change quickly and unexpectedly.

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Learn more about special enrollment periods and CMS Star Ratings at www.medicare.gov. You can also ask a licensed sales agent which 5-star plans are available in Tennessee.

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Humana is a Medicare Advantage HMO, HMO SNP, PPO, SNP and PFFS organization and a stand-alone PDP prescription drug plan with a Medicare contract. Humana is also a coordinated care plan with a Medicare contract and a contract with the Tennessee Medicaid program.

Enrollment in any Humana plan depends on contract renewal. Every year, Medicare evaluates plans based on a 5-star rating system.  

Doug Haaland is the president of Humana Tennessee Medicare. 

This article originally appeared on Nashville Tennessean: How you can benefit from Medicare's special enrollment periods