The Medicare Advantage Open Enrollment Period

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 Medicare Advantage Open Enrollment Period only applies to those currently enrolled in an Advantage Plan as an individual. Those enrolled in an Advantage Plan provided through a former employer should be mindful of the company’s annual enrollment period.

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

• Change from one Advantage Plan to another Advantage Plan
• 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 and that is problematic.

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, Massachusetts and Maine, Medicare supplement applications are medically underwritten and the company does not have to accept you if you have pre-existing conditions.

There are 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.

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. Of course, not all Advantage Plans are the same. As always, do your homework.

Anyone on Medicare has a staggering array of coverage options. In our opinion, there are too many to be useful. When considering an Advantage Plan, factor in the possibility that the Plan may manage expensive services more aggressively than original Medicare. We say this not only because we’ve observed it but because Advantage Plans spend considerable amounts of money on marketing and television ads, pay generous commissions to brokers who sell their products, add some additional benefits beyond what original Medicare covers, and most are for-profit companies that are in business to make a profit. How is this possible with roughly the same amount of money to spend on a Medicare beneficiary enrolled in original Medicare? Some would say the Advantage Plans are more efficient and that’s why they can spend all this money that is not spent on those with original Medicare. Those plans where doctors and others work to coordinate care can be more efficient than those in a fee-for-service setting but many Advantage Plan networks are simply fee-for-services providers under contract.

If you feel you’ve made a wise choice, fine. But if you’ve enrolled in a Medicare Advantage Plan and have buyer’s remorse, you can change Advantage Plans or return to original Medicare during this time of year.

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