By Shannon Martin, Aging Wisely, LLC
Medicare Open Enrollment for drug plans takes place each year towards the end of the year. Starting in 2011, the period will be from October 15th to December 7th. During this time, Medicare recipients can switch Medicare Part D programs (prescription drug coverage) or enroll or disenroll from a Medicare Advantage plan. From January 1st-February 14th, those enrolled in a Medicare Advantage plan can also disenroll and switch back to regular Medicare (this is the only change that can be made during that period). It is worth each Medicare recipient’s time to evaluate current Medicare coverage and consider alternatives based on his/her specific situation. A number of studies have indicated that many Medicare recipients are in the wrong plan and paying more than necessary. Even if an individual’s current plan is appropriate, it is important to understand the coverage, how it works, and Medicare recipients’ rights.
Medicare Advantage (or Part C): There are several key issues and considerations that arise when someone is enrolled (or considering) a Medicare Advantage (MA) Plan. MA plans are an option to receive a number of the various Medicare benefits via a private insurer instead of the traditional program. Typically, these plans will have preferred providers or networks (or providers may not accept the coverage due to the reimbursement rates) and may require a primary care physician or have other restrictions. They may also include additional benefits such as eye or dental care or gym memberships, and the deductibles, co-pays, etc. are usually less expensive for the recipient. If a person is enrolled in a Medicare Advantage Plan and is not pleased with the plan/coverage and choices, there are several special enrollment periods to make changes in addition to the annual open enrollments.
One issue Medicare Advantage recipients sometimes encounter is the situation where they must get inpatient rehabilitation and do not like the facilities available under their plan for skilled nursing. The OEPI (Open Enrollment Period for Institutionalized Individuals) may help. Persons “institutionalized” (i.e. residing in or moving in and out of a skilled nursing facility and other eligible institutions) have a continual enrollment period. The person can disenroll from a Medicare Advantage plan while in the facility and return to regular Medicare (or a different MA if accepting enrollment) the beginning of the next month.
Additionally, there is what is known as the “trial period”, which is the first 12 months after someone signs up for a MA plan for the first time. During this time, he/she can choose to switch back to regular Medicare coverage (and get guaranteed issue on a Medigap plan). There are various other Special Enrollment periods, for situations such as moving, becoming eligible or losing coverage from an employer or other entity and plan contract violations. If a client feels they truly did not understand the coverage or were misled, it is worthwhile to contact Medicare or an attorney who specializes in this area about rights and appeals.