Some Can Switch Medicare Advantage Plans Mid-Year

I am not happy with my Medicare Advantage plan. Can I switch plans in the middle of the year, or do I have to wait until open enrollment for next year’s plans?

In most cases, you cannot switch plans midyear. To choose a Medicare Advantage plan for next year, you must wait until open-enrollment season, which runs from October 15 to December 7. There’s a special enrollment period -- January 1 to February 14 -- that lets you switch out of a Medicare Advantage plan into traditional Medicare (and sign up for a stand-alone Part D prescription-drug policy), but you can’t use that window to move from one Medicare Advantage plan to another.

A new option, however, allows the relatively few people who have access to a five-star Medicare Advantage plan to switch plans once during the year outside of open enrollment. (Medicare Advantage plans are assessed on 50 measures, focusing primarily on each plan’s coverage, communications and customer service. The highest rating is five stars.) The catch: There are only 12 five-star Medicare Advantage plans in the U.S. (out of 569 plans available) in 2012, up from just three in 2011. The largest five-star plan is Kaiser Pemanente’s Medicare Advantage plan, which is available in 31 counties in California. There are other five-star plans in certain counties in Colorado, Hawaii, Illinois, Iowa, Maine, Massachusetts, Oregon, Washington and Wisconsin. To see whether any five-star plans are in your area, go to the Medicare Plan Finder and sort the Medicare Health Plans (another name for Medicare Advantage plans) by overall plan ratings when the list of available plans pops up, or call 1-800-Medicare (1-800-633-4227). The star ratings are assessed once per calendar year.

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If you do have the opportunity to switch to a five-star plan, first decide whether it suits your needs. “Choice, convenience, coverage and cost are still important,” says Jan Berger, M.D., chief medical officer for Silverlink Communications, which helps Medicare Advantage plans communicate with consumers. “If you are lucky enough to be in an area with a five-star plan, you still have to weigh whether your doctor is in the plan and whether your drugs and hospitals are covered by the plan.”

You can find more information about each rating in the plan’s page in the Medicare Plan Finder. Also see Medicare’s Choose Higher Quality for Better Health Care fact sheet for more information.