6 Things You Need to Know About Using Medicare Advantage and Part D Plans

January 9, 2018

by: The My Medicare Matters Team

So, you have chosen a Medicare Advantage (MA) or Prescription Drug (Part D) plan during Open Enrollment that fits your needs, but what happens next? While your new Medicare plan will send you all the introductory paperwork you could ever need, it may be a bit overwhelming. You probably have lots of questions about the difference between MA plans and Original Medicare (Parts A & B), how to pay your premium, and switching plans if you’re unhappy.

Here are some of the most important things you need to know as you begin to use your enhanced Medicare coverage.

1. You will be mailed a membership card

Keep these cards safe and bring them, along with your Original Medicare card, to the doctor or the pharmacy when you go. You will also need to let your providers know which plans you have enrolled in. If you lose your Part C or Part D card you will need to contact your plan to get a replacement. If you don’t have your plan’s contact information on hand, you can look it up using the Medicare plan finder.

2. Everyone with Medicare is entitled to the same rights

No matter what coverage they decide to enroll in. Remember: You have the right to appeal certain decisions about your coverage or payment, file complaints about your care, and get emergency and urgently needed care when you need it. As a Medicare beneficiary, you are also responsible for knowing when enrollment periods are, ensuring your health care provider accepts your Medicare plan and contacting Medicare if you feel like your doctors, agent, or plan has misled you in any way.

3. There is assistance available with finding new providers

If your doctors, prescription drugs, or pharmacy network are not covered your new plan can provide you with a list of in-network providers from which to choose. 

4. You have 3 different options when paying your premium

1.) check, 2.) automatic debit, or 3.) credit card. In some cases, you may be able to get your premium withheld from your Social Security check. If you selected this option when enrolling in your plan, know that it may take up to 3 months to have the premium deducted from your Social Security benefits, and you may need to either pay it as a lump sum at that time or pay another way until the deduction kicks in. Plans must notify you in writing before they cancel your policy due to insufficient payments. Contact your plan directly to learn about their premium payment policy.

5. You may have several opportunities to switch Medicare Advantage and/or Part D plans

If you don’t qualify under special circumstances, you may still switch from one Medicare plan to another you can do so during the following periods:

If you are unhappy with your Medicare Advantage coverage, you can return to Original Medicare or switch to a new Medicare Advantage plan the Medicare Advantage Open Enrollment Period (MA OEP) Jan. 1 – Mar. 31 and the Open Enrollment Period. Most people can switch Part D plans once a year, during the annual Open Enrollment Period (Oct. 15 – Dec. 7). But if you receive Extra Help with your Medicare prescription drug costs, you can switch plans as often as once a month.

6. You may be able to switch to a Medigap plan

There are generally only a few situations that allow you to leave Medicare Advantage and pick up a Medigap plan without being subject to medical underwriting. If you join MA when you first start Medicare at age 65, then you have 12 months to change your mind, drop MA, and get Original Medicare with a Medigap policy.

Now is the time to start using your coverage. You might have prescriptions that need to be refilled, yearly exams that need scheduling, and other healthcare needs. If you still have questions that need to be answered you can find the answers right here on My Medicare Matters, by contacting your plan directly, or by contacting your local State Health Insurance Assistance Program (SHIP) for free, federally funded, unbiased Medicare counseling.