Not What I Signed Up For
Medicare open enrollment has ended, the mailbox is returning to the normal minimal junk mail, the tv is no longer bombarding you with constant adds, and the phone now only rings when family is calling.? But what do you do now that open enrollment has ended but you are not happy with your current Medicare Advantage plan!? Due to some major changes in the network availability starting in 2025 several of the Minnesota & Iowa regions got to find out firsthand how disruptive it can be.?? In SE MN where we are located, we got some shocking news about network availability after January 1st. Some of the Major hospitals and clinics had pulled out of the network and left our members feeling like they may have been bamboozled into a plan that is not living up to what was promised. ??No one should ever be left feeling like they can not get the care they need from where they need to.? Because of this we will discuss what enrollment periods are out there including initial enrollment, annual enrollment periods, Special Enrollment periods, and five-star enrollment options.
Turning 65 can be overwhelming at first, even your mailbox is stuffed full.? This can happen as early as a year before you turn 65 but really seems to pick up in the 6 months before your birthday. ?Why?? Well, the companies know you have a seven-month window for your initial Medicare Enrollment.? This consists of the three months before the month you turn 65, through your birthday month and to three months after the month you turn 65. ?During this initial enrollment period you can enroll in Parts A and B, Medicare Advantage, Medicare Supplement (with no health history), and Prescription drug coverage.? If you served for our country or eligible for any VA benefits this is also a great time to speak to your local VA office as some VA members are eligible for additional benefits.? Including but not limited to Drug Coverage, Hospital Care and more.
We all have heard and seen the bold banners flashing and warning you “Don’t miss your open enrollment period!”.? So, what is open enrollment?
?Every year, Medicare’s open enrollment period is October 15 - December 7.? This is a period where you have the option with your Medicare health and drug plans to make changes.? October 15 to December 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.? This is also normally the time that you will see the carriers and drug companies announce any changes to things like cost, coverage, and what providers and pharmacies are in their networks.?? Members will be notified during this time by the carriers with either an annual notice of change or evidence of coverage.? It is important to review these materials as this may be the only indicator of any plan changes for the upcoming year. If members are satisfied that their current plans will meet their needs for next year and it is still being offered, they do not need to do anything.? However, if someone is not happy with the upcoming changes or there is a change in network that has caused an issue, this enrollment period allows the member to make the plan changes needed for January 1.
?I reviewed all my documents, and everything looked good, shortly after the first of the year though I found out that my plan is no longer covering my hospital!? Now what do I do.
?This sounds like a nightmare to many of us who dread change, but it became a very real problem for several members this last year. After reviewing their plan documents several members were notified in January that their hospital was not able to come to an agreement with the carrier and will no longer be in network with their Medicare Advantage plan. Members in the rural areas are now presented with a unique challenge. Many seniors may not drive and losing the only major hospital services in the region can leave a member with no options close to home.
So, what does someone do in this situation?
The annual enrollment period becomes a life saver.? This period takes place from January 1 through March 31 annually. It allows individuals enrolled in a Medicare Advantage plan to make a one-time election to go to either another Medicare Advantage plan with prescription drug coverage, Medicare advantage plan without prescription drug coverage or Original Medicare.? If you prefer to move away from MAPD plans but still need hospital coverage a Medicare Supplement is available any time of the year. (Some MED SUP plans do require a health history application). In either case, your new coverage will start on the first day of the month following the month you make a change.
?Sometimes we may have a sudden life change that can cause a disruption that influences your Medicare coverage, because of these situations we have Special Enrollment periods.? These work like the Marketplace and employer plans.? Special Enrollment Periods can vary from situation to situation.? These are typically only offered for certain situations that happen in your life, like moving to a new address, losing or changing your current coverage, getting Medicaid, or getting Extra Help to pay drug costs.
Some of the Most Common SEP Are:
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If you notify your Medicare plan carrier before moving to another state or service area: You can switch starting the month before you move and two months after you move.
?? If you notify your Medicare plan after moving to another state or service area: You can switch from the moment you notify your plan through the next two months.
? You have two months after you lose your coverage to sign up for a new Medicare plan. Your coverage will begin the first day of the month after you sign up.
You can sign up once per calendar quarter during the first nine months of the year. Your coverage will begin the first day of the month after you qualify or ask to join a new plan. These are not all that is available but seem to be the most common.
?But I keep hearing about something called a 5 Star Enrollment is that another option?
If a Medicare Advantage Plan, Medicare drug plan, or Medicare Cost Plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period to switch from your current Medicare plan to a Medicare plan with a “5-star” quality rating. ??What does a "5-star" quality rating mean??Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. A plan can get a rating between 1 and 5 stars. A 5-star rating is considered excellent. These ratings help you compare plans based on quality and performance. Medicare updates these ratings each fall for the following year. These ratings can change each year. ?
Health Insurance can be confusing, even when it seems like all you need to do is pick a plan.? Making the right decision for you is what matters most and with life ever changing it is good to know that your health plans can change with you.? So, if you are not pleased with your plan carrier, your current network or just your overall coverage know that you still have options at least for a little bit this month.? Feel free reach out and we will be more than happy to help! ?