Solicitations for Medicare Advantage plans once again have been arriving in the mail, promising the best bargain since sliced bread. A case in point is one from Emblem Health, a managed-care company in my area that says it considers me what they call a “candidate” for their “special needs plan.” I don’t qualify for such a plan.
The solicitation was interesting, though, for what it promised. Free transportation to and from doctor, hospital, and lab appointments, but only up to 24 one-way trips a year. It also promised “no referrals.” Did that mean no referrals were necessary to visit specialists? The solicitation didn’t say.
That seemed highly unusual for what I am assuming is a Medicare Advantage HMO. HMOs usually require consumers to obtain referrals to specialists.
But shoving aside the questionable advertising pitches such solicitations are known for, that one reminded me that beneficiaries are now in a special enrollment period until the end of March. The special enrollment period, which began Jan. 1, gives seniors a three-month window during which they can switch some of their Medicare arrangements.
It’s also a good time for those who will soon be turning 65 to begin thinking of their options and learn what the rules are once they make their selections.
Until the end of March, if you have a Medicare Advantage plan, you are allowed to switch to another Medicare Advantage plan. Or you can drop a Medicare Advantage plan, return to traditional Medicare and buy a Part D stand-alone drug benefit, says Tricia Neuman, a senior vice president of the Kaiser Family Foundation and a Medicare expert.
What you cannot do, if you have traditional Medicare along with a stand-alone drug plan, is switch to a new drug benefit that might let you save more money on your prescriptions. You can do that only during the open enrollment period in the fall.
Keep in mind that if you drop a Medicare Advantage policy and switch to traditional Medicare, you might have trouble buying a Medigap policy to fill in holes in Medicare coverage. Only four states have what’s known as guaranteed issue Medigap insurance. In New York, Connecticut, Maine, and Massachusetts, people dropping Advantage plans in favor of traditional coverage can buy a Medigap even if they have preexisting conditions. In other states they may not be able to do that.
When might it be useful to consider other options during this brief window for switching?
If you have an Advantage plan that has a drug benefit built in as part of the coverage but you believe you can do better with another plan’s drug benefit, then you might want to do the math and see if a switch helps the budget.
Too many consumers fail to do their shopping for the drug benefit when, in fact, they can save thousands of dollars in pharmaceutical expenses by choosing one plan over another.
This special enrollment period gives you a second chance to save on drug costs.
But you may want to switch Medicare Advantage plans or choose traditional coverage, for other reasons that are becoming clearer. Research is beginning to surface that shows Medicare beneficiaries with high medical needs may have trouble accessing care in some Medicare Advantage plans.
Medicare defines those with high needs as people who have three or more chronic diseases and a functional limitation in activities of daily living or in performing routine daily tasks.
The Office of the Inspector General in the Department for Health and Human Services reported last fall that those with Medicare Advantage plans sometimes had trouble getting claims paid under those plans, or they reported other problems getting help from the plan.
The inspector general said that because so many seniors now have these plans, even low rates of inappropriately denied payments or services could cause “significant problems” for beneficiaries and their medical providers.
Just last month new research reported in JAMA Internal Medicine found that Medicare beneficiaries with high medical needs and those eligible for both Medicare and Medicaid were much more likely to disenroll from Medicare Advantage plans than other beneficiaries.
Researchers at Brown University and Columbia University found that disenrollment from Advantage plans “may indicate that plans do not meet the preferences of enrollees with significant chronic illness.”
This study and the inspector general’s findings offer a cautionary tale for people who will be new to Medicare in the coming months and for sick beneficiaries in Medicare Advantage plans who may want to reevaluate their options during this special open enrollment and next fall when open enrollment comes around again.
What has been your experience in choosing health insurance for this year? Write me at firstname.lastname@example.org.