Every year, insurance companies offering Medicare Advantge plans (HMOs, PPOs, private fee-for-service plans [PFFS], etc) have the option to drop out of the program or not renew their Medicare
contract. When this happens, beneficiaries must find a new insurance plan or return to traditional Medicare. If your senior is one of the Medicare Advantage plan members affected, their
notification letter may have gone "astray."
- For some seniors, correspondence that looks like form letters or advertisements tends to pile up or get discarded. If yours is covered by an Advantage plan, you might want to double-check to
be sure the plan will continue participating next year, because the time for your senior to make elective changes is between Nov. 15 and Dec. 31 of this year.
- If your elder's insurance carrier is dropping out effective January 1, and if your elder does not actively choose to switch to a new plan of choice, he or she will automatically be enrolled
in the traditional Medicare program effective January 1.
- Medicare does this automatically so that no senior will be without basic coverage come the first of the year.
- If your senior transfers his or her health insurance to another Advantage provider before the end of the year, the switch should be sinple. It is somewhat more complicated if you elect to
move from an Advantage program to traditional Medicare and want full coverage.
- You should be very aware that if your senior transitions to traditional Medicare, you should seriously consider secondary or "gap" insurance to cover the deductibles and co-payments that are
part of traditional Medicare. The non-renewing Advantage plan is required to provide members with information about gap plan options.
- A beneficiary who returns to original Medicare because their Advantage plan is not renewing has a "guaranteed issue right" to purchase a Medigap policy. Because you want coverage on January 1
of next year it is important to begin reviewing these policies as soon as possible.
There is a limited amount of time wherein a senior can choose a Medigap policy under the "guaranteed issue right" without regard to pre-existing conditions. Seniors must make their choices
from 60 calendar days before the date their coverage will end to 63 days after the coverage ends. Obviously, the sooner the better.
- Like all insurance products, the marketing information for Medigap insurance policies can be very confusing. The last thing you and your elder want to do is meet with a representative from
every company. Look for an independent broker who represents multiple companies, including the major players, and let your broker present you with the two or three most optimal plans for your
particular health issues and circumstances.
- If your senior will return to traditional Medicare, there will be no automatic drug coverage. This, too, must be purchased separately. In order to be sure their prescriptions are covered on
January 1, seniors should be enrolled at least two weeks before the end of the year, and preferably sooner. Like the Medi-Gap plans, it is often easier to research the multiple plans available
through an independent insurance broker. If you choose to research your options yourself, the Medicare website has comparative information.