IS YOUR MEDICARE ADVANTAGE PLAN TAKING A HIKE?

Dear Medicare Beneficiaries,

If you have received a letter from your insurance provider stating that your current MAPD or PDP plan will be discontinued in 2013 you MUST ACT ACCORDINGLY DURING THIS AEP BETWEEN OCT 15th to DEC 7th. Doing nothing will either revert you back to Original Medicare A & B and or no drug coverage. Starting the year without drug coverage can be a hassle so to avoid receiving a Late Enrollment Penalty (for not having Rx coverage) do your due diligence and search for one. Contact your customer service, it’s more than likely they offer a comparable plan to the one you are losing. This also goes for individuals losing their Medicare Advantage (MAPD) plan as well.
Now, for those of you who DO NOT want to replace your MAPD with another one available in your area you have the option of reverting back to Original Medicare and picking up a Rx plan GUARANTEED ISSUE. THIS MUST BE DONE (App completed and submitted) prior to the last day in Feb. 2013. This guaranteed issue provision allows you to enroll into any Medicare Supplement plan without being subject to underwriting. For those beneficiaries who live in the northeast region of the US ( NY, ME, NH, & CT) underwriting is of no concern for you because it is illegal for insurance companies in these states to underwrite a Medicare beneficiary.
However, unfortunately for the rest of you, it is quite legal in other states for insurance companies to weigh the risk of enrolling you as a member. They have the right to deny your enrollment based on the risk you may cost them. Is this fair? Not in my opinion but you have to remember that insurance is a business. As a consumer you must approach the selection process of a plan in the same manner. Do the research and find out which plan offered in your area works best for you.
Retrospectively however this may be an opportunity for you, as a consumer, to seize the moment and take advantage of the loop holes the system has created. What I mean is simply this… For any individual enrolled into Medicare A & B, if your health is where it should be at your age or better (meaning you are quite healthy, and only visit your PCP or a specialist a couple times a year) then enrolling into a MAPD would be beneficial. Your premiums are relatively low and your co-pays for services provided would be minimal because you don’t seek treatment for any issues often. This coincidally keeps your out of pocket expenses (OOPE) low. However if your health is declining and you KNOW that you DO or WILL NEED to seek treatment for conditions that ail you the Medicare Supplement route might be the best path to take. This is where you can take advantage of the system. Normally, any Medicare beneficiary outside of the states I mentioned above looking to enroll into a Medicare supplement plan (outside of their initial enrollment period [IEP]) would be subject to underwriting which may prevent you from being enrolled and getting coverage. Coincidentally however, since your MAPD is being discontinued in 2013 (no longer available) that gives you an SEP or special enrollment period that allows you to enroll into any Medicare Supplement plan guaranteed regardless of your health condition. This is a tremendous benefit because if you can afford the premiums then you will be eligible for the most comprehensive plan (Plan F) out there.
I understand that this situation is annoying and cumbersome but trust me when I tell you this “you are better off doing the research to find a plan similar to what you have or different; it doesn’t matter.” AS LONG AS YOU FIND A PLAN TO REPLACE WHAT YOU ARE LOSING BEFORE THE END OF THE YEAR. If you sit and do nothing, come the new year your OOPE will be drastically higher than what you are used to. My advice is take the time with someone to go over your replacement options so you are aware and can forecast your health care expenses for 2013. There’s nothing more frustrating than looking for financial assistance with your health care costs and being left in the wind to cover it yourself…..unless you “Got it like that!”

Affordable Care Act Continues to Benefit Seniors — for Now

In response to the Healthcare Leadership Council (HLC) article regarding Medicare Advantage Continues To Benefit Seniors — for Now, there are a few things left unsaid that may have a great impact and change the perception that some may think the Affordable Care Act (ACA) will diminish these options that benefit seniors.

If you haven’t read the hyperlink I have attached,….. Read it. Ok,…..that’s a little harsh. No one is “Forcing” seniors out of popular MA-PD plans. That is not the “true” issue here. What is, however, is the result of individual agents/brokers convincing Medicare beneficiaries of enrolling into a plan that unfortunately doesn’t meet their health care needs specifically; thus leading to financial responsibility that, one, the beneficiary was unaware they had, or two, were under they impression that their current provider would cover. The idea that “it is wrong to disrupt the elderly’s existing health coverage” would be a good argument to adjust the current health care reform bill, if Medicare beneficiaries’ health coverage were working effectively and efficiently. It, however, is not.

Medicare MA plans are designed to include all of the same benefits as Medicare A+B, and may include Rx drugs. The only difference, however, is that the beneficiaries’ health care management is administered by the insurance provider. Not to mention, even though Medicare no longer is the administrator of the beneficiary’s health care, they still pay the independent provider for overseeing the provision of care for that same beneficiary. This, HLC, neglected to mention continues to draw from the federal budget allocated for Medicare beneficiaries nation wide causing even more stress on the government funded social insurance. That being said, the beneficiary is responsible for cost-sharing/co-payments for Medicare covered services provided. These programs, as the previous article has conveyed, can be cost effective for seniors who are still relatively healthy and see a physician only a couple times a year. Enrollment into MA-PD plans saves these beneficiaries the cost of spending hundreds a month on supplemental coverage, Rx drug plan premiums and their Medicare Part B Premium/and or deductible. Hence the appeal to these plans, however, there is a downside….

“Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius recently released a new report showing that the government’s health care fraud prevention and enforcement efforts in taxpayer dollars in the 2011 Fiscal year. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled.”

– HHS.Gov,

Due to the cost-sharing/co-payments beneficiaries are responsible for, there is still some responsibility borne to the insurer to coordinate benefits (entitled to the beneficiary) with Medicare. When the responsibility of submitting claims forms are left to the provider of these services, for example primary care physicians or specialists, this CAN and HAS been the result; Seniors being taking advantage of and in many cases overcharged for services they might be entitled to. Because of the ACA the Department of Human Health Services (HHS) has diligently overseen the government’s administration on fraud, waste and prevention which is now being closely monitored. Theoretically, this should improve a beneficiaries’ overall experience in an MA plan, and allow for more distribution of Medicare/Medicaid funding to those who really need it.

By no means is the quality of coverage going to be decreased if a Medicare beneficiary opts to enroll back into Original Medicare A+B, unless the provider of services is taking shortcuts to cut costs for providing care. The Affordable Care Act has been implemented to increase care across the senior population, not diminish its quality. That would not make any sense. The essence of this reform is to improve quality by cutting down on fraud and putting back into the Medicare funding program what was taken from it illegally and with reckless abandon…..beneficiaries’ and taxpayers hard earned dollars. Access to more funds can lead to a variety of improvements within the Medicare/Medicaid programs such as increased reimbursement rates, quicker access to patient records by sharing of private health information (PHI) within a secured virtual database, etc.

What we need to understand, and respect is that health care is an ever-changing environment that constantly requires innovative and effective implementation to improve the quality and efficiency of providing care. To be honest, its mainly a trial and error process that we must be patient with. Im not saying we are to drag our feet in coming up with useful solutions, but we must allow some time to analyze the “ripple effect” of what we are trying to accomplish. With regards to the patient experience, we will get a better understanding of what works and what doesn’t, and use this vital information to improve the entire process holistically from initial contact to final disposition.

MA-DP Deadline Quickly Approaching

The MADP,

Medicare Advantage Disenrollment Period, deadline is quickly approaching.

The MADP, which begins January 1st and runs until February 14th and replaces the Open Enrollment Period, is an opportunity for beneficiaries to return to Original Medicare. It is not an additional enrollment period nor is it an opportunity for Medicare Advantage members to switch to different MA Plans.

Allowable Actions during the MADP:

People enrolled in an MA-PD plan may disenroll from the MA-PD and will have the opportunity to enroll in a standalon Prescription Drug Plan (PDP). Important: MA-PD members who enroll in a standalone PDP during this period will be automatically disenrolled from their current MA-PD and will not have the option of enrolling in another Medicare Advantage Plan.

Members who are in a Medicare Advantage only plan may request disenrollment from the MA plan and will then receive a Special Election Period (SEP) to enroll in a PDP standalone plan. The SEP is available from the time the disenrollment request is made until the member enrolls in a PDP or after February 14, whichever comes first.

Members who have both a standalone MA and a standalone PDP may disenroll from the MA plan, but may not make a change to their current standalone PDP.

A beneficiary who disenrolls from an MA or MA-PD plan using the opportunity afforded by the MADP may enroll in a Medicare Supplement policy upon returning to Original Medicare. However, using the MADP does not give the beneficiary guaranteed issue rights under federal law to prevent health-based underwriting of the Med Supp policy. In some cases, State Medigap laws may offer additional guaranteed issue rights to beneficiaries who are affected by the MADP.

Members who have a standalone PDP, but are not enrolled in an MA plan may not make any change to their current PDP plan and may not enroll in an MA plan.

People with Original Medicare who are not enrolled in any Part C Medicare Advantage plan have no options under MADP to make any change in their Medicare coverage.

Note: The effective dates of the MA disenrollment under the MADP and the PDP enrollment under the coordinating Part D SEP do not have to be the same. If a beneficiary disenrolls from an MA plan, he or she has until the end of the SEP (February 14th) to enroll in a PDP. Thus an individual could disenroll from an MA plan in January (effective February 1) and not choose a PDP until February (effective March 1). However, the individual must make a PDP election by the end of this SEP or wait until the next valid Part D election period in order to enroll in a PDP. In all cases, the effective date for the enrollment in a PDP may not precede the date of the MA disenrollment.