More on
Medicare Advantage Plans
Bob Mason
Originally
published in Coastal Senior
(September 2007)
In case you missed my last
column, I am not a fan of
Medicare Advantage Plans.
Proponents of the plans will
tell you they offer “more
options” to seniors. In my
experience “more options”
often is code for “more
complex”.
Advantage Plans also cost
the taxpayers more. The
government pays about 20%
more to insurance companies
for each Medicare
beneficiary than it pays
directly to doctors and
hospitals on behalf of
Medicare beneficiaries under
traditional Medicare.
I came down particularly
hard on Medicare Advantage
“Private Fee for Service
Plans” – a type of plan that
promises much, often comes
up short, and has been
accused by the government of
using overly aggressive (not
to mention illegal) sales
techniques (like forgery).
All of this is my opinion.
I imagine there could be
reasonable people who would
disagree – and there
actually may be some happy
Medicare Advantage enrollees
who have experienced some –
umm – advantages to
Medicare Advantage.
Some Important
Considerations
In case you really want to
take a look at a Medicare
Advantage Plan, consider the
following:
-
Are your favorite doctors and hospitals covered
by the plan? Do they
accept the plan’s terms
and conditions?
-
Do you need a referral to see a specialist?
-
Can you get care outside the plan's service
area or network? How?
-
What costs are involved in the plan (premiums,
deductibles, copayments)?
-
Are there copayment requirements for lab tests,
diagnostic tests,
x-rays,
MRI scans, or CT scans?
In case you want that “nice young man” from the insurance company
to come by, consider:
-
It’s OK to have someone
with you when you
discuss a Medicare
Advantage Plan or any
insurance product with
an agent. If an
insurance agent comes to
your home uninvited,
make an appointment to
meet the agent at a time
and place that is
convenient to you. Do
not invite strangers
into your home.
-
Obtain the agent’s
business card so you can
contact him or her
later.
-
If you are satisfied
with your current
coverage, you do not
need to change.
Bailing Out
Speaking of changing, you
need to get a handle on how
(and how often) you can
change from one type of plan
to another – say from
traditional Medicare to an
Advantage Plan and back.
Oh, alas! More complexity.
If you enroll directly in an
Advantage plan for the first
time upon becoming Medicare
eligible or you have dropped
a Medigap (Medicare
Supplement) ONCE, you can
voluntarily disenroll from
their plan anytime within
the first 12 months of
enrollment. If it has been
more than 12 months since
enrollment, there are
limitations as to when you
may disenroll. Read on.
First you have an Annual
Election Period (AEP),
which runs from November 15
through December 31. If you
are in a Medicare Advantage
Plan you can switch to
Original Medicare (and a
Part D Prescription Drug
Plan) or you can switch to a
different Medicare Advantage
Plan. Changes will take
effect January 1 of the
following year.
Next you have an Open
Enrollment Period (OEP) for
Medicare Advantage that runs
from January 1 through March
31 of each year. If you are
in a Medicare Advantage plan
with Prescription Drug
coverage you may switch to
another similar plan offered
by another company or return
to Original Medicare and
select a stand-alone Part D
Prescription Drug Plan. You
may not switch to an
Advantage Plan that does not
provide Medicare
Prescription Drug coverage.
There are a host of other
complexities on the types of
plans you may switch from or
to. Remember: all of this is
meant to provide you with
options! Just imagine the
vista of possibilities
opening before you!
My best advice is to be
aware that November 15
begins a time when you can
make some changes. Do your
homework and explore those
changes.
Unfortunately, I do not have
space for specifics. But
once you locate a new plan,
you’ll need to notify both
your old plan and Medicare.
KEEP COPIES OF EVERYTHING.
Get help from a
knowledgeable friend, adult
child, or counselor.
Occasionally government does
work well. The US Marines
are one example. Another
good example is federal
funding of state programs to
help seniors with Medicare
and other health insurance
issues. They work well and
have trained counselors.
In Georgia you may find help
through the Coastal Georgia
Area Agency on Aging. Call
them at
1-800-580-6860 and scream “HELP!”. You can also call the
GeorgiaCares State Health
Insurance Information
Program at
1-800-669-8387.
In South Carolina call the
low country office of
Insurance Counseling
Assistance and Referrals for
Elders Program
(I-CARE) (whew!)at
843-726-5536 and scream “HEY-YELP!” (They sound different in
South Carolina – my
opinion). By the way, the
South Carolina I-CARE website is excellent:
www.state.sc.us/ltgov/aging/Seniors/ICARE.htm.
We need a KISS Program (Keep
It Simple Silly), but I’m
NHMB (Not Holding My
Breath).
Next month, one of my
favorite topics: Living
Trusts . . . you might just
be able to live without
them.
Bob Mason, certified elder
law attorney by the National
Elder Law Foundation,
practices in Savannah,
Georgia, and Asheboro, North
Carolina. Email Bob at ram@masonlawpc.com or visit www.masonlawpc.com.
