Copayments, or copays, are fixed amounts set by your Medicare Advantage (MA) plan that you need to pay at the time of a visit to a doctor or specialist. Many MA plans will set a fixed amount between $10 to $45 (or more) that you’ll pay out-of-pocket. If your health changes and you find yourself going to a doctor’s office more frequently, these copays can start to add up.
As we age, we may face changes in our health. In the past year, if you’ve gotten sick, developed a chronic illness, or sustained an injury that requires regular care, you may be feeling that your copays are too high. If that’s the case, it might be time to compare your current Medicare coverage with other plans in your area.
Before you start to consider other options, review your current Medicare coverage. What do you pay in copays to a doctor? Do you pay more to visit a specialist? How many times did you have to visit a medical provider last year? What was the total amount of copayments you were responsible for?
Compare these costs to other MA plans available in your area. MA plans differ in costs and coverage – and copays can vary. Different types of Medicare Advantage plans will offer a range of benefits too. For instance, an HMO may have a lower copay, but you may have to visit doctors within the plan’s network. A PPO, on the other hand, might allow you to see doctors outside the network for a higher copay. And, if you qualify for Medicare and Medicaid, you might join a Dual-eligible Special Needs Plan and get help paying some or all of your doctor copays.
Online plan comparison sites make it easy to find other plans that might meet your needs. If you decide you’d like to switch to a different Medicare Advantage plan, you may do so during an enrollment period.
When can I switch to a plan with lower doctor copays?
Medicare recipients may be able to make changes to their coverage during the following enrollment periods:
- Annual Election Period (AEP). During AEP, which is October 15 through December 7, you can make changes to your Medicare coverage. During this period, you may switch from one MA plan to another, change from one PDP to another, drop Original Medicare and enroll in an MA plan, or even drop you Medicare Advantage plan and revert to Original Medicare (and enroll in a PDP at that time).
- Medicare Advantage Open Enrollment Period. From January 1 through March 31, you can make a single change from one MA plan to another,
- Special Enrollment Period (SEP). If you experience certain changes in your life, you may qualify for an SEP. For instance, if you move into assisted living, or move out of your current plan’s service area, you may be able to change your coverage during a specified period of time.
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