The Annual Medicare Advantage Open Enrollment Period is Upon Us!

There are many Medicare enrollment periods. Some enrollment periods are relevant to those applying for Medicare; others are relevant to those already on Medicare. The enrollment period we are currently in only applies to those who are enrolled in a Medicare Advantage Plan. Those enrolled in an Advantage Plan provided through a former employer should be mindful of the company’s annual enrollment period, but we believe they would also be able to return to original Medicare and a freestanding Part D Plan during this period if so desired.

The Medicare Advantage Open Enrollment Period began on January 1st and ends on March 31st. During this time, someone can:

• Change from one Advantage Plan to another Advantage Plan (if enrolled as an individual rather than through an employer)
• Return to original Medicare from an Advantage Plan and enroll in a Part D drug plan

We think that many people who enrolled in an HMO product might consider a PPO product because an HMO product limits your coverage to a specific network of doctors. Of course, if you are satisfied with the network available with your HMO plan, there is no reason to consider changing. Unfortunately, many people don’t check which hospitals, doctors, and specialists are in their network until they are sick.

But remember that a PPO product may not guarantee you access to all hospitals. Some specialty hospitals have a history of limited participation with Advantage Plans although the trend is in the direction of more participation as one would expect with the growth of Advantage Plans. As mentioned in the video, however, we spoke to two different individuals with Yale University retiree medical during their group open enrollment period last fall. Yale University retirees currently have coverage through an Aetna PPO. Both individuals wanted to be seen at the Mayo Clinic and were told the Mayo Clinic did not accept their Plan. They could not schedule appointments.

It is also worth reminding those who want to return to original Medicare that buying a Medicare supplement can be challenging. The guaranteed issue period for buying a Medicare supplement ends six months after one’s Part B effective date. After that, in all states except New York, Connecticut, and Massachusetts, Medicare supplement applications are medically underwritten and the company does not have to accept you if you have pre-existing conditions. In some situations, Plans will accept you but charge a higher premium. We had a busy Fall with new clients wanting to return to original Medicare from their Advantage Plans. We have included UnitedHealthcare’s underwriting questions as an example of the information insurers request. Click the button below to view the PDF.

There are other limited circumstances when one has a guaranteed issue right to purchase a supplement beyond the six months post Part B enrollment noted above. If, for example, you enrolled in a Medicare Advantage plan for the first time and within a year decide to disenroll, you likely have a guaranteed issue right to purchase a supplement. If this describes your circumstance, time is of the essence. Moving out of your Advantage Plan’s service area is another example. And some supplement rules are changing. Some states have added more options for residents around their birthdays. It is difficult to keep up with state rules as they change so if in question, consult your state insurance department.

We often sound negative about Advantage Plans and that’s because we have seen instances where a Plan has been aggressive in denying care we believe would have been covered or covered longer under original Medicare. We have also seen clients who saw an out-of-network physician have a troublesome claims experience because the out-of-network office refused to submit the claim. We have also dealt with individuals who didn’t realize they were enrolling in an Advantage Plan and/or were heavily influenced by a broker. We often see individuals choose an Advantage Plan because of a zero premium or very modest premium Plan. But always remember to review the out-of-pocket maximum of your Plan. In 2024, Plans can have an out-of-pocket maximum as high as $8,550.

Anyone on Medicare has a staggering array of coverage options. In our opinion, too many to be useful. If you feel you’ve made a wise choice, fine. But if you’ve enrolled in a Medicare Advantage Plan and want to change to another Plan or return to original Medicare, you have until March 31st to do so.

As always, please do your homework. Thanks!