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!”

Advertisements

It’s Finally Here!

It’s here!!! Managed Care Consultants’ inaugural newsletter has just hit the stands!!!….. Just kidding, but it is available to those who want it. And it’s FREE. Inside, we have described for you in detail who we are and what we do. We are ‘THE ‘educational resource guide to understanding Medicare for seniors. We are committed to enlightening those who are willing to learn and help prevent health care fraud. Just click the link below! Check back with us frequently, we’ve always got something new and interesting to share. We ” Tell It Like It Is.” Your opinions and comments on how we can improve are always welcome. Don’t be afraid to share your questions or concerns. We are a community of educators and we learn best from one another’s experiences. Take care and hope to hear from you. Don’t forget to click the MCC Newsletter link below!

Calvert Louden, MCC Newsletter 8-12