The Reason For Dueling Open Enrollment Ads
Question: Why are there still commercials about Medicare products on TV? I thought Open Enrollment was over?
Answer: Many of us are aware of Medicare’s Annual Open enrollment Period running from October 15 to December 7 annually. You may not know about the January 1 to March 31, Medicare Advantage Open Enrollment Period (MA-OEP). This three month opportunity is for individuals with a Medicare Advantage Plan, allowing them to switch to any other type of insurance product they choose, with or without drug coverage.
Medicare Advantage Plans (MA) are plans that replace your Original Medicare Benefits and usually include prescription drug coverage. There are over 45 MA Plans available in Chautauqua and/or Cattaraugus County. That is definitely fewer than years in the past, but that is a lot of options. They all have different monthly premiums, co-pay structures and networks of providers, so I will speak broadly to this situation.
The Medicare Advantage Plans are health plans that replace traditional Medicare, such as HMO’s (Health Maintenance Organizations), PPO’s (Preferred Provider Organizations), and PFFS (Private Fee For Service) plans. Each year, insurance companies adjust the coverage in their MA plans, these changes include premiums, co-pays and deductibles, extra benefits, etc. So the plan you let roll over, may be different that you believe it to be.
During this January to March Enrollment Period, you can go from a MA Plan (with or without drug coverage) to a different MA Plan (with or without drug coverage), or Original Medicare AND a Stand-Alone Drug Plan (PDP) or Original Medicare and NO drug coverage.
It is also important to remember that if you are dropping a Medicare Advantage Plan and returning to Original Medicare, you should seriously consider adding on a Medicare Supplement Plan. So leaving your HMO, or PPO or PFFS plan would default to your Original Medicare coverage, and then you would need to decide to enroll in a Drug Plan and a Medicare Supplement Plan. These two things do not happen without you actively enrolling in a product of your choice.
So if for some reason you chose NOT to get drug coverage as part of your Medicare Advantage Plan you have now, you could change that choice from January 1 to March 31.
During this period of time, your new coverage will begin the first of the following month. If you change your insurance during March, your new plan will begin April 1. This is significant because after April 1, you may be locked into your plan for the remainder of the year without a Special Enrollment Period (SEP) available to you.
This MA-OEP is also useful for those individuals who are deciding that they don’t want to stay in their Medicare Advantage Plan for any reason. One reason could certainly be that your premiums or copays have increased. Another reason could be that your doctor, hospital, or pharmacy, no longer participates with the Medicare Advantage Plan you had thought you wanted to keep. Another reason that people sometimes switch out of MA Plans is that they have a serious medical problem that may be covered more comprehensively with Original Medicare. (In this situation I am thinking about something like Cancer or Renal Failure.)
You also may want to switch your plan because you have gone to the pharmacy over the last few weeks and found that your medications are more expensive than you anticipated, or more than last year. Remember you decided not to switch your insurance, but the insurance company probably made changes you didn’t realize would impact you. You could save money by evaluating your insurance choice before it is too late, and you are locked into your plan for the year.
In the event that you decide to go back to Original Medicare, I always stress the importance of evaluating the option of adding on a Medicare Supplement Plan in this situation. In New York State, you are allowed to enroll in a Medicare Supplement Plan anytime. In this situation there are no pre-existing conditions limitations because you are going directly from one product to another, and the “pre-existing limitations” clause does not apply to you.
This MA-OEP is certainly one of the ways to switch your insurance right now until March 31! So you will continue to see commercials on TV, receive mail from and possibly calls from Medicare Advantage Plans.
Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.