When Can I Change my Medicare Advantage Plan in California?

This is a common question we get and it usually revolves around...regret!

Being over age 65, regret is probably well-tread but let's see if Advantage plans finally allow us to undo choices we've made (unlike that summer of 1978)!

There are different times you can change your Advantage plan depending on your scenario.

We'll cover the most common available to all Advantage plan members and then drill down to the special triggers available.

Our credentials (so there's no regret there):

Here are the topics we'll cover:

• Why most people want to change their Advantage plans in California
• The Annual Open Enrollment period (Oct 15 - Dec 7th) to change Advantage plans in California
• The Open Enrollment period (Jan 1st - March 31st) in California
• When can Medi-Medi plan members change Advantage plans
• Big triggers for changing Advantage plans during the year
• Can I change my Advantage plan if I'm in a Nursing home or other facility?
• Final note on making changes to Advantage plans

Let's get started!

Why most people want to change their Advantage plans in California

This usually revolves around a few different reasons:

• My plan won't work with certain doctors or hospitals for current care
• My plan doesn't cover my medications (or they're very difficult about it)
• The benefits aren't what I thought they were?

Sound familiar?

It's usually around access to care...either providers or actual procedures.

This can either be due to a change in health (plan won't let me get a certain procedure or see better doctors for a given situation)

OR

The plan was supposed to cover X with doctor X but it doesn't!

Very common and usually down to someone pushing a given plan at enrollment before checking on the available options.

Then there are all the changes that life can throw at you!

• Moving to a new location
• Changes in Medi-Cal status, LIS (Additional Help), or health itself

Occasionally, there are changes that occur at no fault of your own...the carrier making changes in terms of who they work with.

See how to get Scripps with Medicare as an example...they literally said they would stop working with ANY Advantage plan in 2024 leaving 1000's of seniors in the lurch.

We'll cover all these. Let's start to work our way from most to least common reasons to change our Advantage plan.

First, the one we all have!

The Annual Open Enrollment period (Oct 15 - Dec 7th) to change Advantage plans in California

We all know this one. It's the little Holiday gift that just keeps on giving.

All Advantage plan members are allowed to change their plans during the annual open enrollment regardless of...well anything.

The period is from Oct 15 - Dec 7th and the effective date will be Jan 1st the following year.

You can even change your plan choice easily by enrolling in a new plan during that period and it will replace the existing choice.

The effective date will be Jan 1st either way.

It's easy to apply for a new plan here:

Make sure to enter your doctors, medications/dosages, and preferred pharmacy. Then sort by "Total Estimated Cost" up top.

If you qualify for Medi-Medi, LIS (Extra Help), or have a chronic illness, select "Show Special Needs Plans" up top.

The quote/application system is free, secure, and fast across dominant Advantage carriers in California.

Okay...we're all pretty familiar with the year-end maelstrom...let's start looking at less well-known times to change Advantage plans in California.

The Open Enrollment period (Jan 1st - March 31st) in California

This is the mulligan or "whoops" option!

During the first 3 months of the year, everyone is allowed to change their existing Medicare Advantage plan to a new one.

This window was designed for people who picked a plan during the Annual Enrollment above (Oct 15 - Dec 7th) and realized it wasn't a good fit.

Remember the doctors not really being in your plan or certain meds not on the list??

Same process as above.

Quote/Enroll with here (zero cost to you) and it will replace your existing plan and the effective date will be the 1st of the month following enrollment.

Same rules to get the best quote:

• Enter doctors
• Enter medications/dosages and pharmacy
• Sort by "Total Estimated Cost"
• Check on "Show Special Needs Plans" if eligible for Medi-Cal, LIS, or have a chronic illness

The new plan will automatically replace your old plan with Medicare so that's automated.

There aren't special requirements to make the change. It's a do-over! Hopefully, that helps a lot of readers.

We just had a member whose current carrier wouldn't work with doctors for a procedure.

They were worried they wouldn't be able to change since it was due to these reasons.

But it's March! We submit for a carrier that will work with those doctors and it's more lenient (PPO Advantage plan) with Aetna and we're off to the races (April 1st eff date of course).

That means - of the year, we're fine to make changes.

Okay...let's keep drilling down. Medi-Medi land next.

When can Medi-Medi plan members change Advantage plans

For people who have Medi-Medi (newly eligible or existing), they have even more flexibility to change plans.

It's basically a monthly ability to change now!

The eff date will be the 1st of the month following enrollment.

Same rules apply but make sure to select "Special Needs Plans" since the better options for people with Medi-Cal may very well (likely) be one of these since they're designed specifically for these people.

One note...LIS or "Extra Help" also has this option. We're happy to help you find out your status if new to this whole world at no cost to you!

Okay...it's past March, we don't like our plan, and we don't qualify for Medi-Cal.

Big triggers for changing Advantage plans during the year

Let's walk through some of the most common triggers, but reach out to us with your specific situation, and we'll chase it down at help@calhealth.net or book a chat

• You change where you live
• You lose your existing coverage
• Change in Medi-Cal or LIS status
• Chronic illness status change (gain or lose)
• Dropped Medigap, still in "trial" period with Advantage plan
• Want to join a 5 Star plan

Those are the big ones.

Essentially, if your options change due to a big life change for you (move, Medi-Cal, LIS, or chronic illness).

OR

Changes to the carrier or plan offered to you. This is either the carrier involuntarily changes your plan or the providers that they work with.

Those aren't the only triggers...a big list is here: Medicare Special Enrollment Periods

It can get confusing. Reach out to us...we'll chase down your situation.

Let's continue!

Can I change my Advantage plan if I'm in a Nursing home or other facility?

We usually get this call from children who are frantically working to help their mom or dad.

The whole introduction to nursing homes, hospice, and more is brutal. And very confusing.

Many of our parents are on Advantage plans which may have been fine for general health but suddenly, it's a bad fit for this new phase.

This usually revolves around the old plan not working with a chosen facility. Usually, a facility that the parent is already in!

OR

The parent is newly eligible for a Special Needs Plan revolving around facility-based care (I-SNPs) which are tailor-designed for people in this situation.

The official definition:

"Institutional Special Needs Plans (I-SNPs) are SNPs that restrict enrollment to MA eligible individuals who, for 90 days or longer, have had or are expected to need the level of services provided in a long-term care (LTC) skilled nursing facility (SNF), a LTC nursing facility (NF), a SNF/NF, an intermediate care facility for individuals with intellectual disabilities (ICF/IDD), or an inpatient psychiatric facility."

https://www.cms.gov/medicare/enrollment-renewal/special-needs-plans/institutional

Since facilities are so tied into this world, they are well-versed in helping seniors navigate changes.

We're happy to help research with any questions around I-SNPs.

That's a wrap...of sorts.

Final note on making changes to Advantage plans

Don't go it alone. There's no cost for our assistance, and you see the reviews above.

If we can't help or if there aren't better options for you, we'll tell you so. We don't sell, and we don't push.

Reach out to help@calhealth.net or let's chat: https://calendly.com/dennis-jnw

Happy changes!