It’s do-over season for Medicare Advantage plans
By Mary Beth Franklin
Members can switch health and drug plans during the annual open enrollment, which runs through March
The heavily advertised annual Medicare enrollment season that runs from Oct. 15 to Dec. 7 each year may be over, but millions of Medicare Advantage members still have a do-over option if they want to change their existing health plan for any reason. Sadly, most people don’t realize they can swap their dud of a plan for something better through the end of March.
Of the nation’s 60 million Medicare beneficiaries, more than a third of them — 22 million people — receive their coverage through Medicare Advantage plans that are administered by private insurers.
The Medicare Advantage open enrollment season, which runs from Jan. 1 through March 31, affects only Medicare Advantage members. It does not apply to people enrolled in original Medicare, which includes Part A hospital insurance and Part B medical insurance and is operated by the federal government.
During Medicare Advantage Open Enrollment, Medicare Advantage members can switch to a different Advantage plan or drop Medicare Advantage altogether and return to original Medicare. But original Medicare doesn’t cover everything, so many Medicare beneficiaries also buy supplemental Medigap insurance to cover deductibles and co-pays, plus a stand-alone Part D prescription drug plan.
Medicare Advantage premiums are often cheaper than original Medicare when you consider the added monthly costs of a Medigap policy and a stand-alone prescription drug plan. And Advantage plans often offer extra benefits not provided by original Medicare, such as vision and dental care, prescription drug coverage and free gym memberships. Some Medicare Advantage plans also offer new home health and wellness benefits, such as respite care for caregivers, in-home meal delivery and limited transportation to a doctor’s office, hospital or pharmacy.
But there are tradeoffs. In exchange for lower monthly costs, Medicare Advantage members must agree to use the plan’s network of health care providers in a specific geographic area, so it may not be a good choice for snowbirds who live elsewhere part of the year or those who travel from one RV park to another. And Advantage plans usually require co-payments with each service, which can add up over time, particularly for diagnostic tests and visits to specialists.
Medicare Advantage plans can change from year to year, altering benefits or eliminating certain drugs from their formularies. And doctors can drop out of a Medicare Advantage plan’s network at any time.
“A lot of people get excited about a lower monthly premium or a free gym membership, but they didn’t realize that their doctor wasn’t in the network,” said Danielle Kunkle Roberts, co-founder of Boomer Benefits, a national health insurance agency. “Or maybe they realize that they don’t like the plan’s business model that requires them to get a referral to see a specialist.”
“Think of Medicare Advantage open enrollment as a do-over,” Ms. Roberts said. But many beneficiaries don’t know about it because government regulations discourage marketing during this period to prevent churning enrollments.
“Agents can’t advertise,” she said. “But we can suggest solutions when consumers contact us.”
Ms. Roberts urged consumers who are unhappy with their current Medicare Advantage plan to call Medicare at 1-800-MEDICARE or their State Health Insurance Assistance Programs. Consumers can also consult a Medicare insurance broker, such as Boomer Benefits, for free help as brokers are paid by the insurance companies.
But perhaps the best thing Medicare beneficiaries can do is set up a personal account at medicare.gov and use the site’s personal plan finder to search for other plans in their zip code, Ms. Roberts said. The reason the personal account is so important is that Medicare beneficiaries can list all of their medications and dosages and save the list for future use — something you can no longer do on Medicare’s public plan finder tool, which requires you to reenter that information every time you use it.
For people who want to drop their Medicare advantage plan and return to original Medicare, timing is critical, Ms. Roberts said. People who apply for a Medigap policy after their initial enrollment period surrounding their 65th birthday are subject to medical underwriting and can be charged more for a Medigap policy or denied coverage altogether.
“Start early because it could take a few days or a few weeks to be approved for coverage,” Ms. Roberts said. “You don’t want to wait until the end of March to find out your Medigap application was denied.”
She recommends applying for Medigap first. Once approved, you can cancel your Medicare Advantage plan and enroll in a new Part D Prescription drug plan.
If you try to do it in the reverse order, you can have a problem, Ms. Roberts warned. If you apply for a Part D plan first, you will automatically be disenrolled from your Medicare Advantage plan. And if you are subsequently denied Medigap coverage, you could be stuck with original Medicare for a year without supplemental coverage. That’s why it is a good idea to work with an insurance brokerage that knows the ropes.
Contact your local Government Department Of Insurance office to get more details.
Health Insurance Information Program (SHIIP)
State Health Insurance Assistance Program (SHIP)