This is the second in an ongoing series of informative Medicare posts courtesy of MedicareFAQ. You will see a ton of what are basically ads pushing Medicare Advantage plans. Few balance the pros and cons because they are saying that these plans offer more coverage. I'd suggest reading this article closely before deciding which type of Medicare is right for your parents, your spouse, or you. You will then be able to make an educated decision. - Carol
This new enrollment period is replacing the Medicare Advantage Disenrollment period that used to run from January 1st to February 14th annually.
This new period will give additional freedom to Medicare Beneficiaries that are on Medicare Advantage plans.
What is a Medicare Advantage Plan?
A Medicare Advantage plan is a health insurance that Medicare Beneficiaries can elect and replace their Original Medicare benefits with.
These plans are required to cover the same services as Original Medicare and provide a Maximum out of pocket annually.
A Medicare Advantage plan (MAPD) sometimes include additional coverages that Medicare does not cover, such as dental, vision, and hearing coverage.
These plans are networked based usually HMO (Health Maintenance Organizations) or PPO (Preferred Provider Organizations).
These styles of plans are very inexpensive, however, in most cases, you are still required to pay your Part B premium in addition to any plan costs.
This all sounds good and they have their place, however, they can end up costing the beneficiaries significant out of pocket costs and can control the types of services they can have.
Original Medicare allows beneficiaries to go to any doctor nationwide with no referrals or restrictions of types of coverages.
If a beneficiary elects to choose a Medicare Advantage plan you are giving up the freedom of their choice of Doctors and an administrator dictates the services and treatment the beneficiary can have.
The most comprehensive coverage a beneficiary can have is Original Medicare along with a Medicare Supplement.
This will allow the beneficiary to have access to more doctors, get the treatments their doctors recommend, without the need for an administrator controlling the medical care and coverages.
When can I change a Medicare Advantage Plan?
There are enrollment periods that allow you to change or drop your Medicare Advantage plan throughout the year. The most common is the Annual Enrollment Period (AEP). The AEP is the annual period from October 15th to December 7th annual that allows Medicare Beneficiaries to make any changes they choose with their Medicare Coverage.
Starting January of 2019 the Medicare Open Enrollment Period returns beginning January 1st and running until March 31st , during with a Medicare Beneficiary on a MAPD can make changes to their coverage.
Unlike the Annual Enrollment Period (AEP) the Open Enrollment Period (OEP) only allows beneficiaries already enrolled in a MAPD to make changes to their coverage.
In the new OEP a Medicare Beneficiary with a MAPD can do the following:
- Change from one MAPD to another MAPD
- Drop a MAPD and Return to Original Medicare
- Drop a MAPD, return to Original Medicare, and pick up a Part D Prescription Plan (PDP)
- Drop your Stand-Alone PDP plan
The other major difference in the OEP and the AEP is when a plan change is made in the OEP, it will begin the next month, and then will be locked in until the AEP.
When a beneficiary changes plans during the AEP, it will not begin until the 1st day of January.
What you cannot do during the Medicare Open Enrollment Period:
- Change from Original Medicare to a Medicare Advantage Plan
- Change from one PDP to another PDP
Why would I want or need to change in the OEP if I just enrolled in the AEP?
The main reason why people on Medicare Advantage Plans want to change coverage is the need for better dental coverage.
Many of these style plans offer dental coverage. Unfortunately, most only offer cleanings and x-rays. In addition to only really covering preventative coverage, it is increasingly difficult to find dental providers that take these plans.
Another major reason why beneficiaries will need to change their MAPD is doctor’s networks. The Medicare Advantage Plans are yearlong contracts, unfortunately, the doctors that take these plans can drop the plans when you are locked into the MAPD.
The number of doctors leaving these network plans is growing yearly, and if your doctors drop the plan, in most cases it does not give you the right to get out of your plan. You will instead have to change doctors.
Other reasons stem from Beneficiaries not understanding their coverage or options. There are many cases in which a beneficiary goes for a service or needs medical equipment thinking they will be paying a small co-pay, only to find out they are only covered for 80% of the cost, like Original Medicare.
This causes financial surprises and fluctuation of costs for the beneficiary that is on a fixed income. Because of this, it makes it impossible to budget and plan for your care.
Beneficiaries are growing wise the Advantage plans and are starting to opt for more comprehensive, budgeable coverage like a Medicare Supplement (Medigap) with Original Medicare.
These coverages allow for the maximum freedom for providers and facilities, it also allows a beneficiary the ability to budget monthly to ensure their health coverage without the fear of any surprises.
This type of coverage gives you the freedom to go to the best doctors in their respective fields and facilities to receive your treatment.
It will also allow you and your doctor to decide what treatment is best for you and without the plan dictating what treatments you must try first before getting the one the doctor recommends.
Most Medicare beneficiaries find this out too late. Unfortunately, it is usually once they have had a major medical issue such as cancer that they find out the shortcomings of their MAPD.
Additional Coverage Options
For some Beneficiaries the MAPD may be their only option, if you fall into this category there are some additional coverages you can get that will help make your advantage plan more comprehensive and give you a better overall coverage.
Critical Illness plans are growing in popularity as of late with beneficiaries realizing that with many critical illnesses they are going to be required to foot a large bill.
These plans will provide the beneficiary with a lump sum tax-free check to help offset the high costs associated with certain critical illnesses.
Hospital Indemnity plans are another great way to counter the high copay per day if you must go into the hospital. They pay you a fixed amount per day for each 24-hour period you are admitted into the hospital.