By Mark Covell, Albuquerque insurance executive
In early June, Presbyterian Healthcare Services announced it would be leaving the Medicare Advantage space, ending its senior plans December 31. The provider has been offering Medicare Advantage plans to the people of New Mexico for decades, so if you’re one of the 30,000 members left wondering, “What do I do now?” you’re not alone.
When your Medicare Advantage Plan leaves, you have a couple of options. The first thing to know is that your current plan will continue to cover you until the very last day of the year, so you have some time to make a game plan. Now is not necessarily the right time for you to jump ship from your Presbyterian plan, either. Because your Presbyterian plan is leaving, you’re entitled to special enrollment periods and benefits you wouldn’t normally have — so this is a good opportunity to use that circumstance to find a plan that truly fits your needs.
Two primary options are these: You can move to another Medicare Advantage Plan for 2027, or you can move to a Medicare Supplement Plan with guaranteed issue. Having guaranteed issue for a Medicare Supplement Plan means you won’t have to undergo medical underwriting to qualify. You’ll be accepted regardless of your health status.
The key difference between Medicare Supplement and Medicare Advantage is that Medicare Advantage plans have a network and work most similarly to the plan you’ve been on. Medicare Supplement plans are nationally accepted by any provider that accepts Medicare patients. If you decide to enroll in a Medicare Supplement Plan, you will also need to find a standalone Prescription Drug Plan (PDP) to avoid potential lifetime penalties.
There isn’t a one-size-fits-all plan that can take the place of your Presbyterian coverage. However, here is a list of variables to consider when trying to determine which new plan is best for you:
- Your income and plan cost;
- Current and potential future health care needs;
- Doctors you use or may wish to;
- Prescriptions;
- Your location and that of providers.
Change is never easy, especially when it involves something as important as your health coverage. But this transition also gives you a chance to step back and reassess whether your current setup truly fits your needs, or whether a different type of plan might serve you better going forward. Take the time between now and year’s end to review your options carefully and consider asking questions of local experts.
