Last Chance to Change Medicare Health Plans for
2010: Window Closes March 31
Medicare Rights Center says seniors should know
Medicare private health plan will not work with a supplemental Medigap
plan as with Original Medicare
March 5, 2010 Senior citizens have one last
chance to change their Medicare health plan before they are locked into
their plan for the rest of 2010. During the Open Enrollment Period,
January 1 and through March 31, people with Medicare are allowed to
change their choice of Medicare health coverage once, according to the
Medicare Rights Center.
They cannot, however, add or drop the Medicare
drug benefit (Part D), and cannot switch from one stand-alone
prescription drug plan to another.
Most people with Medicare will not be able to
change their health plan again until 2011. The following is based on
information provided by the Medicare Rights Center.
A person who is enrolled in a Medicare private
health plan (also known as a Medicare Advantage plan or, in some cases,
a Medicare HMO) with drug coverage can switch to another that also
offers drug coverage, but not to one that does not offer drug coverage.
They can also switch to Original Medicare and buy a
stand-alone drug plan. If someone has Original Medicare with a
stand-alone drug plan, they can switch to a Medicare private health plan
with drug coverage. They cannot, however, stay in Original Medicare and
change only their stand-alone drug plan, as this would be considered a
Medicare drug coverage change, not a health coverage change.
"Changing how you receive your Medicare health
benefits is not simply a matter of changing to a plan with a cheaper
premium," said Joe Baker, president of the Medicare Rights Center.
"Switching plans can change which doctors you are
allowed to see, access to benefits you may need as well as the cost of
your care. And since you are allowed to make just one change, be sure
you understand how the new plan works before signing up. Ask questions,
or call us or your local State Health Insurance Assistance Program
(SHIP) for help. Don't let a salesperson use the March 31 deadline to
pressure you into signing up for a plan."
SHIPs are federally funded programs that are
available in every state; they provide answers to Medicare questions
free of charge.
A person who is considering a Medicare private
health plan, like a Medicare HMO, should ask a number of questions
before enrolling, including:
● Will I be able to use my doctors? Are they in
the plan's network and are they taking new patients who have this plan?
● Are my prescription drugs on the plan's
formulary (list of covered drugs)?
● Does the plan require that I get "prior
authorization" before my prescription will be covered, or impose other
restrictions (like limiting the quantity or requiring that I try a
cheaper medication before it will cover a more expensive one)?
● How much is my monthly premium?
● Is there an annual out-of-pocket maximum?
(After I spend a certain amount on medical services, will the plan cover
all my copays?) Are all services included in the out-of-pocket maximum?
● What service area does the plan cover?
A full list of helpful questions is available on
Medicare Interactive, provided by the Medicare Rights Center.
Consumers who decide to change plans should do so
by enrolling in the new plan. This will automatically disenroll them
from the old plan. (Disenrolling from one plan and enrolling in another
count as two changes, which is not allowed.)
Medicare consumers who have coverage from a former
employer should be aware that signing up for a Medicare private health
plan can sometimes cause permanent loss of that coverage. They should
always check with the company that provides their retiree coverage
before enrolling in a Medicare private health plan.
Consumers should also know that a Medicare private
health plan will not work with their supplemental "Medigap" plan as it
does with Original Medicare. Medigaps supplement Original Medicare only.
People who have Original Medicare with a Medigap
and are considering switching to a Medicare private health plan should
be aware that in certain states and situations, they may not be able to
get their Medigap policy back, or may have to pay a higher premium if
they have a history of illness.
Rules about purchasing Medigap policies differ from
state to state, and consumers are advised to use the resources mentioned
below to learn their state's rules before making a switch.
Under certain circumstances, people may be eligible
for a special enrollment period to change health or drug plans. For
example, people who were misled into enrolling in a Medicare private
health plan qualify for a special enrollment period.
Medicare consumers have several free resources to
help them make the right decision for their needs:
● The Medicare Rights Center offers free
resources for people who want to learn more about Medicare private
health plans. Medicare Interactive, a free, web-based counseling tool,
is available at www.medicareinteractive.org <http://www.medicareinteractive.org/>
.
People who prefer to speak with a counselor can do
so by calling the toll-free hotline at 1-800-333-4114. Counselors are
available Monday through Friday, 9:00 am to 5:00 pm (Eastern Time).
● State Health Insurance Assistance Programs (SHIPs)
also offer free guidance. Consumers can find their local SHIP office by
calling 1-800-677-1116.
Medicare
Rights Center is a national, nonprofit consumer service organization
that works to ensure access to affordable health care for older adults
and people with disabilities through counseling and advocacy,
educational programs, and public policy initiatives.
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