Something to Consider before Enrolling in a Medicare Advantage Plan
Medicare Advantage Plans, or Medicare Part C, have been presented to America’s seniors as an alternative to Original Medicare with a prescription drug plan and a standard medigap policy. And it does sound good. Many cost little more than the Part B premium, and the coverage can be comparable to what people are used to, depending on the type of plan. However, Medicare beneficiaries need to be sure it’s the right decision before they make the change to a Medicare Advantage Plan.
Now, I’m not trying to say that people shouldn’t choose Part C. It is a personal choice, and while I’ve been learning a great deal about Medicare in the few months I’ve been working for the Eastern Agency on Aging, I certainly don’t know all there is to know. My father, who lives in New Jersey, has a Medicare HMO plan with a well known national insurance company. He’s happy with the coverage, and it meets his needs. Unfortunately for the people who live in this agency’s coverage area, the same variety of plans that are available in other parts of the country—indeed, even other parts of the state—aren’t available here.
But still, my dad knew about the plan before he got into it. (In fact, the availability of this plan has factored into his decision to move to different areas.) He knew what to expect, and he didn’t have to worry about trying to cancel his enrollment and go back to original Medicare or about switching to another plan.
And switching plans during the Annual Coordinated Enrollment Period, November 15th to December 31st, or during a special enrollment period is an option, but it’s not necessarily without complications. Over the past month I’ve met with two people who had decided to participate in a Medicare Advantage plan and quickly decided to go back to Original Medicare. The plan had a thirty day cancellation policy allowing the return without penalty. One took two weeks to decide to go back, and the other only took a couple of days. Both cancelled during the thirty day window, and both have had months of aggravation since. I’ve helped both of them file the same type of complaint with Medicare—within days of each other.
Both people received timely letters from the plan acknowledging their disenrollment status and stating that they would be returned to original Medicare on the same date. Both of them also received letters from the Centers for Medicare and Medicaid Services stating that their coverage under original Medicare would continue. The problem is that there is a four month gap in the dates for both people. Four months of doctor’s appointments and even multiple hospitalizations and no one to bill for them. The plan tells the medical providers to bill Medicare, and Medicare tells them to bill the plan. Luckily, for both people, the providers have understood the situation. They know what a complex system Medicare is and how long things can take. They’re helping their patients deal with it. They’re letting them take the time with Medicare—and get our help—while the bills pile up, unpaid.
But can you expect that kind of patience from your providers? Do you want to have to rely on it?
I’m not saying that this will happen to everyone, and I don’t want to scare people away from Medicare Advantage Plans. There are many satisfied customers whom we haven’t heard from because they don’t need help with Medicare’s automated phone system or help navigating through a plan’s complex contact information. I’m saying that it would be wise to compare plans and insurance companies. Research them and get some objective information. Perhaps learn about their customer service rankings. Try to be as sure as possible that the plan is right for you before making a change. But you still never know until you do it.
If you have had problems, though, or even if you would like help finding information about different plans. Come into the agency, e-mail us, or give us a call. We can help.
Ted Perrin
ADRC Information and Referral Specialist
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