When Should You Change Your Medicare or Health Insurance Provider?
SmartFinancial Offers Unbiased, Fact-based Information. Our fact-checked articles are intended to educate insurance shoppers so they can make the right buying decisions. Learn More
Most Medicare Advantage plans and individual health Insurance plans have networks of doctors and providers. You’re covered for much more when you see doctors and providers within that network. Depending on the type you have, you may not be covered at all if you go out-of-network unless it’s an emergency. However, you may not be thrilled with the doctors you have or the way your insurer services you. There are many reasons why people change plans and cost saving also tops the list. Here are situations when it makes sense to contemplate changing insurance companies.
Self-Employed or Want Work-Life Separation
If you are a gig worker, you will need to buy your own insurance, even if you’re hired through an agency which will not offer the best or cheapest coverage. If you’re offered employer-sponsored health insurance, you may want to keep your health separate from your job. Even though an employer is not privy to your medical records, some people want extra privacy by buying a private health insurance plan and renegotiating a salary without employer-sponsored health insurance. For people who don’t look to stay with a company very long, having a separate plan is also a good idea, to avoid hiccups between coverage changes.
Better Coverage and Benefits
If you review your previous year’s health care needs and add up the costs, you’ll see how much care you’ll need in the new year. Jot down medical bills, including doctor visit copays, imaging and the deductible on your plan. Buying a higher tier plan may cost more each month but may result in overall savings. If you want to find another insurance company that offers more comprehensive coverage or additional benefits, such as lower deductibles, lower copayments, or better coverage for specific services, it may be worth considering a switch by comparing plans..
When you compare health insurance plans or Medicare plans according to your zip code, you may find that another health insurance company provides similar coverage at a lower premium. If you’re struggling with the cost of health insurance, compare rates at Open Enrollment, come November. Do it now if you have a qualifying event.
Changing the Type of Plan
You may have had a PPO but are willing to stick within the more restrictive network requirements of an HMO to save some money. At that point, you will need to compare rates, plan benefits and out-of-pocket expenses to see which HMO plan will suit you best. You may have to change doctors.
Unsatisfactory Customer Service
If you are dissatisfied with your current insurance company's customer service, claims processing, or responsiveness, it might be a valid reason to seek an alternative insurer.
If you have not had a good experience with the range of doctors you’ve visited since you’ve worked within the network, you should consider changing your network group. If that fails, it’s a good idea to compare health insurance plans based on your current needs for care.
If your current plan does not adequately cover your healthcare needs, such as prescription medications, specialists, or specific medical conditions, it might be the right time to explore other insurance options as well.
If your current insurance company's network does not include your preferred healthcare providers, hospitals or specialists, or if the network is too restrictive and offers no coverage at all to your preferred doctor(s), you may want to switch to a plan with a broader network that better suits your healthcare needs.
Major Life Changes
Life events such as marriage, divorce, the birth or adoption of a child, or the loss of employer-based coverage may qualify you for a Special Enrollment Period (SEP). During an SEP, you can change your insurance company to fit your new circumstances.
Moving to a different area or state may require you to find a new insurance provider, if your current company does not offer coverage in that new location. You are able to buy a new policy outside of the Open Enrollment Period.
Changes in Healthcare Needs
If there are changes in your health, which require more doctor visits and treatments, your current plan may not adequately cover your new needs or cost you too much in out-of-pocket expenses. It may be time to explore other insurance options, with a higher tier plan. Even if you pay more per month, you may save more in overall costs.
If you’re a Medicare recipient, you may want a Medicare supplement that covers emergency medical costs while traveling abroad.
Better Discounts and Incentives
Some insurance companies offer discounts on wellness programs or incentives for maintaining a healthy lifestyle. If you find an insurer that provides more attractive incentives, it could be a reason to consider switching. For instance, many Medicare Advantage plans offer Silver Sneakers discounts on gym memberships and they include dental, vision and hearing coverage.
Policy Expiration or Renewal
Review your current insurance policy before it expires or is up for renewal. This is often the best time to explore other options and make changes for the new year, if necessary.
Open Enrollment Period
During the annual open enrollment period, you have the opportunity to review and make changes to your health insurance plan. If you’re wondering what other options are available to you, this is a good time to switch plans if you find one that better suits your needs.
Change in Network
If your current insurance plan's network no longer includes your preferred healthcare providers, doctors, hospitals, or specialists, or if it's too restrictive, you may want to switch to a plan with a broader network.
Better Prescription Drug Coverage
Changes in your prescription drug needs, formulary, or medication coverage may send you looking for better prescription drug coverage. It’s important to review which medications are covered and how much before you switch.