Medicare Advantage Open Enrollment: Preventing Scams

Consumers can make changes to their Medicare Advantage health and prescription drug coverage during the open enrollment period which runs through March 31, 2025.

Medicare Advantage plans are offered by private companies. They can differ from original Medicare — and from each other — on things like in-network coverage, out of pocket costs, and referral policies for specialists. During Medicare Advantage open enrollment, consumers can switch from their current Medicare Advantage plan to another Medicare Advantage plan, return to original Medicare, or join a separate Medicare drug plan.

To protect themselves, avoid common consumer issues, and reduce their risk of getting scammed, consumers should take care during the Medicare Advantage open enrollment period. Here are some things consumers should keep in mind while considering coverage options:

· Confirm what a plan really includes. If a consumer is thinking about switching to another Medicare Advantage plan, don’t take an ad, agent, or broker’s word for it when it comes to the details. Call the plan directly and ask the following:

o Will your primary doctor, or other doctors you see, be in-network?

o Will your costs (including copayments) change?

o Will your prescriptions be covered?

o Will you need prior authorizations to get the care you need?

· Keep records. When talking to an agent or broker about a plan and coverage, consumers should keep track of who they talked to, when they talked, and what was said. Consumers can ask for a written description of the plan’s terms so they can review it later.

· Get help comparing Medicare costs, coverage, and plans. For local help, contact the State Health Insurance Assistance Program (aka SHIP, at ShipHelp.org). Consumers can find information about their coverage options from an unbiased source at Medicare.gov and by calling 1-800-MEDICARE (1-800-633-4227).

If a consumer thinks they made the wrong plan choice because an agent, broker, or ad gave them misleading information, they should call Medicare as soon as possible.