Should I opt out of my Medicare Advantage Plan if I am expecting a major procedure in 2016? -Timothy J., Peoria, IL

This is a great question, and involves a bit of number crunching on your end. The first thing to note is that this will vary on a case-by-case basis, but looking at potential costs, especially between Medicare Advantage Plans (MAP, or MAPD with prescriptions) and Original Medicare with Supplemental Plans and Part-D for drugs, is something I get asked about quite a lot. Here is how to think about this to find the best solution:

First – If you are thinking of switching now, you are acting at the right time. You have until February 14, 2016 (it is always January 1^st to February 14^th each year) to opt in or out of MAPD, without special exceptions granted in certain circumstances year-round.

Second – This is truly a numbers game, if number crunching is not your cup of tea, please consult a professional, the following is for the DIY folks only!

To figure out if switching is right for you, find out approximately how much it will cost for your procedure, new medication, and each day you expect to spend in the hospital under MAPD and add all of that together (do not forget to take in to account your deductibles, out of pocket maximums, etc.). Now, divide that number by 12 and add it to your monthly premium, this number is your expected cost per month under MAPD. Now, if you find that your expected monthly costs are far higher under MAPD than Medicare with supplemental plans, then your answer is simple.

Finally – If you want to disenroll from an MA-only or a MAPD plan and return to Original Medicare during the allotted time mentioned above, you have a special election period (SEP) to join a Part D prescription plan.

• If you have a MAPD plan, you can either 1) submit a disenrollment request to your MAPD plan and then enroll in a Part D plan, or 2) the easiest way is to properly enroll in a Part D plan first, which then automatically disenrolls you from your MAPD.
• If you have an MA only plan, if just going back to Original Medicare - you must request disenrollment from your MA plan.  If also enrolling in a Part D (RX plan), you may properly enroll in a Part D plan and that will cause your dis-enrollment in the MA plan.

Of course, you should always speak to a professional before committing to any large changes such as this, but it is always a good thing to have a general grasp on your insurance coverage for the year at the start of the year.