Allsup outlines options Medicare recipients have to re-evaluate choices and change plans during first six weeks of 2011
BELLEVILLE, Ill.--(BUSINESS WIRE)-- Medicare annual enrollment ended Dec. 31, but people with Medicare Advantage plans can make certain coverage changes during the new disenrollment period, from Jan. 1 through Feb. 14, according to Allsup, a nationwide provider of Medicare plan selection services and Social Security disability representation.
The Affordable Care Act added the disenrollment period and eliminated the open enrollment period, which previously ran from January to March and provided more switching options.
“There are fewer options, but people with Medicare Advantage plans still have some choices worth evaluating during the disenrollment period,” said Adrienne Muralidharan, senior product specialist for the Allsup Medicare Advisor®. The Allsup Medicare Advisor is an impartial Medicare plan selection service that helps people understand and choose the most affordable and appropriate Medicare coverage for their healthcare needs. (Allsup is not a Medicare plan provider.)
Approximately 12 million people were enrolled in Medicare Advantage plans in 2010. These plans combine traditional Medicare Part A (hospital services) and Part B (medical services). Medicare Advantage plans also may include prescription drug (Part D) coverage as well as dental or vision care.
During disenrollment, people can leave a Medicare Advantage plan and enroll in traditional Medicare. If they had Part D coverage under their Medicare Advantage plan, they must also enroll in a prescription drug plan. If the Medicare Advantage plan they are leaving did not include prescription drug coverage, they can’t enroll in a Part D plan during disenrollment. However, they may be able to obtain Medigap for supplemental coverage of other out-of-pocket expenses not covered by traditional Medicare.
A chart on Medicare options during the disenrollment period can be found at http://www.allsup.com/portals/4/Medicare-Disenrollment-Chart-2011.pdf.
Sorting out the options to replace existing coverage can be a major challenge. While traditional Medicare is standard, most people have more than 30 Part D plans offered in their area. There also are 10 types of Medigap policies with varying deductibles and coverage options such as paying for skilled nursing care. In addition, there are dozens of different Medigap plan providers in each area.
A chart of Medigap policy types is at http://www.allsup.com/Portals/4/2011-medigap-chart.pdf.
Reasons for Disenrolling
There are several reasons why someone may want to disenroll from their Medicare Advantage plan and switch to traditional Medicare during the disenrollment period. Two of the most pressing could be:
- Your preferred doctors no longer participate in the Medicare Advantage network. Some physicians are choosing to limit the Medicare Advantage plans in which they participate. As a result, patients who want to continue to see them are required to pay more costly out-of-network fees. On the other hand, any doctor that accepts reimbursements from Medicare, which most do, are required to see patients with traditional Medicare.
- Your prescription drug coverage is too costly or not adequate. Prescription drug plans have different costs and cover different medications. Some also place restrictions on prescriptions, for example, requiring that a generic drug be prescribed before a brand name or restricting the quantity that can be prescribed. Additionally, drug plans contract with certain pharmacies to create a network. If the network is not conveniently located, this may be another cause for switching.
“People need to understand why they are switching and then sort through all their options,” Muralidharan said. “That can be overwhelming to do in just a few weeks, which is why they may want to look for help in reviewing and identifying their choices.”
Additional Enrollment and Switching Options During the Year
Between the end of the disenrollment period, on Feb. 14, and the start of the 2012 annual enrollment period, now earlier from Oct. 15 to Dec. 7, 2011, individuals can join or change plans for only a few specific reasons. These include:
- Disability: Individuals can enroll in Medicare as early as three months before to three months after their 25th month of disability, as determined by the Social Security Administration.
- Turning 65: Seniors can enroll in Medicare coverage three months before, the month of, and three months after their 65th birthday.
- Moving out of the plan’s service area: People moving permanently out of their plan’s service area are allowed to switch plans anytime during the year.
- Nursing home residents: A person who moves into, lives in, or is leaving a nursing home can enroll in new Medicare coverage anytime during the year.
- Fraud: If a person learns they were enrolled in a plan without their knowledge, he or she can contact their state health insurance assistance program (SHIP) anytime during the year to receive help.
- Low-income: Recipients receiving “extra help” can switch plans as needed to ensure they are getting the most cost-effective, appropriate coverage possible. This includes individuals eligible for Low-Income Subsidy (LIS), both Medicare and Medicaid at the same time (dual-eligible) or Supplemental Security Income (SSI) benefits.
For an evaluation of your Medicare options, please call an Allsup Medicare Advisor specialist at (888) 271-1173 or go to http://medicare.allsup.com.
Allsup is a nationwide provider of Social Security disability, Medicare and Medicare Secondary Payer compliance services for individuals, employers and insurance carriers. Founded in 1984, Allsup employs more than 700 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis. For more information, visit www.Allsup.com.
The information provided is not intended as a substitute for legal or other professional services. Legal or other expert assistance should be sought before making any decision that may affect your situation.
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