By Philip Alsten, RPh
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It’s January and Medicare’s Fall Annual Election Period (AEP) has passed.
So, what happens if you are not happy with the Medicare Advantage plan that you chose and signed up for during the AEP?
What if you did not bother to change plans and you let your existing Medicare Advantage plan just roll over into the new year, but you’ve now come to realize that the plan had changes that you don’t like? Perhaps one of your doctors is no longer in the plan, or your favorite hospital, your favorite pharmacy, or one of your brand name medications is no longer covered by the plan’s drug formulary.
Perhaps you didn’t even realize that a telephone conversation that you had during AEP was from a call center and the person on the other end was not just some friendly customer service representative from an insurance company, but was actually a devious salesperson who got you to answer YES to a few questions on a recorded line, then enrolled you into a new Medicare Advantage plan without you realizing.
What can you do? ……Well, there is good news.
For people on Medicare Advantage Plans, there is another Enrollment Period that allows you to make a change. It is officially called the MA-OEP or Medicare Advantage Open Enrollment Period. Formerly known as the Medicare Advantage Dis-Enrollment Period and that previous name was actually a more accurate description. This period runs from January 1st to March 31st.
From January 1st to March 31st only people who are on a Medicare Advantage Plan can make ONE change. They can do one of the following one time:
- Change from one Medicare Advantage Plan to a different Medicare Advantage Plan, or
- Change from a Medicare Advantage Plan back to Original Medicare**
The change that you make will generally become effective on the 1st of the following month.
** A word of caution for those considering going from Medicare Advantage back to Original Medicare and wishing to purchase a Medigap (Supplement) Plan. Most people wanting to do this will have to go through UNDERWRITING by the insurance company selling the Medigap (Supplement) Plan. So, it is critical that you DO NOT cancel or disenroll from your Advantage Plan and DO NOT enroll into Stand-Alone Part D Prescription Drug Plan UNTIL your application for the Medigap (Supplement) Plan has been approved and accepted by the insurance company.
If you fail to follow the correct order of steps, you could wind up with just Original Medicare and no other supplemental coverage. Leaving you responsible for all of the Part A and Part B expenses that Medicare does not cover. Such as the $1,556 Part A Deductible each time you are admitted to the hospital, as well as the 20% Part B Coinsurance with No Limit to your out-of-pocket spending.
Another opportunity to make a change to your Medicare Advantage plan exists.
This one is called the 5-Start Special Election Period (5-Star SEP).
If there is a 5-Star rated Medicare Advantage Plan in your area, you can use the 5-Start SEP once in a year to move from your existing Medicare Advantage Plan to the 5-Star rated plan. The 5-Star SEP can only be used once, anytime from December 8th to November 30th.
CMS regulations dictate an election period hierarchy when 2 or more election periods overlap.
The 5-Star SEP is low in the hierarchy, which means that all other Elections Periods must be exhausted prior to utilizing the 5-Star SEP.[/vc_column_text][vc_single_image image=”12507″ img_size=”full”][vc_column_text]This can all be so confusing, and it’s often in your best interest to utilize the services of an agent who specializes in this area of insurance. Find a local, independent insurance agent (broker) that you can trust to help you navigate through all the Medicare rules and regulations.
Unlike lawyers, accountants, doctors, dentists, mechanics, electricians, plumbers or barbers, there is NO ADDITIONAL COST to work with an independent insurance agent (broker).
Insurance companies build commissions into their product costs, so whether you deal directly with the insurance company yourself, or utilize the free services of an agent, you pay the same premium amounts.
Independent brokers represent multiple insurance companies, so they are more likely to find you the right plan that fits your unique needs. This is in comparison to working with a “captive” agent from one insurance company, whose only options are the products of the one company he/she works for.
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