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What Are Options To Change Medicaid Plans?

Question: My Medicare insurance is okay, but I saw a plan I would like to switch to. What opportunities for change do I have?

Answer: There are 20 Special Enrollment Periods (SEP) that are available to all individuals with regard to Medicare coverage. I will focus on one of the 20 SEP’s for switching your insurance plans in 2022, Five Star Medicare Part D Plan. We don’t always have Five Star Medicare Part D plans, having 17 Five Star Medicare Advantage Plans is exciting. There are no Five Star Stand Alone Prescription Drug Plans (PDP’s) in 2022. This Five Star Rating is the highest possible rating for any insurance product and represents excellent performance on more than 35 unique quality and performance measures.

The Five Star SEP is available to you all year in 2022. This year we have three different Five Star Insurance Plan Companies available to us in our region. The 17 Five Star Plans are all Medicare Advantage Plans, three Highmark BlueCross/BlueShield of WNY PPO (Preferred Provider Organization) Plans, all the Independent Health PPO & HMO (Health Maintenance Organization) Plans, and all the Univera Senior Choice HMO & HMO-POS (Health Maintenance Organization + Point of Service) Plans.

Whichever of these seventeen plans you choose would replace your current coverage if you chose to use this SEP. That means you could switch from your current plan to a Five Star Plan (any of the 17 available) any time during the 2022 year.

You should evaluate your current coverage and compare it to these 17 plans. As always, it is important to understand the coverage offered and that your medications are included in the formulary of the plan you choose.

The HMO plans require you to stay in network for all your medical care. The HMO-POS plans allow you to have limited money to cover services outside of the usual network (usually $1,500 or $3,000 per year). The PPO plans have bigger potential network of providers, and the option of Out Of Network providers.

The Highmark BC/BS BlueCard network has 47 partnering coverage states, which is included in the Forever Blue PPO 751 and Freedom Nation plan. This BlueCard network is a useful tool in planning for travel and second homes.

Having these 17 Five Star Plans means that in 2022 everyone has this Five Star Special Enrollment Period as an opportunity to switch their insurance during 2022 if they need or want to. The Five Star SEP can only be used once during a calendar year.

There are 20 Special Enrollment Periods available to individuals during the year. The other SEP’s may be useful to you and your situation. We are always here to help you evaluate whether or not switching your insurance makes sense.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call 716-720-9797 or email SLM@lutheran-jamestown.org.

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