Quite a few seniors are giving up their Medicare Advantage plans and going back to Medicare.  This change can still be made before March 31st and here’s how it’s done.  People dropping Medicare Advantage should sign up for a Medicare Supplement and a Part D plan, and timing is very important for the application process.

I know lots of seniors are moving back to Medicare because my contact at Blue Cross Blue Shield of Arizona  told me they have been overwhelmed with Medicare Supplement applications.  I know timing is important because I’ve had a heck of a time getting my clients’ Medicare Supplements finalized after we submitted them on December 16th.  Here’s what happened.

My contact at Blue Cross Blue Shield (BCBS) assured me that two weeks was enough time to process Medicare Supplement applications for a January 1 effective date.  This may be the case under normal circumstances, but this past December was not normal because so many seniors decided to apply for Medicare Supplements at the same time. 

I told my clients they should disenroll from their Medicare Advantage plan only when they got confirmation from BCBS that they were covered by the Medicare Supplement.  However, BCBS was overwhelmed with Med Supp applications in December. No word came from BCBS in December. No word came in early-January.  Finally, in mid-January, letters arrived saying my clients were covered “effective January 1st”.    But there was a problem with this.

Because my clients had not disenrolled from their Medicare Advantage plans, their Medicare Supplement (effective Jan. 1) would do them no good, so they should not pay a January premium.  So we faxed letters explaining the circumstances and waited for BCBS to change their effective date to February 1.  Apparently, changing the effective date is not so easy – or at least they had to get in line.  And so I spent the month of January checking on the applications.  And today, January 29th, I have finally been told that everything is confirmed for February 1. 

Now my clients can disenroll from their Medicare Advantage plans and here’s how they do it.  They must enroll in a “stand-alone” Part D plan.  Back in December we had reviewed Part D plans, so they were ready to call and enroll over the phone.  Once their Part D application goes to Medicare, Medicare sees in their record that they have been enrolled in a Medicare Advantage plan with a drug plan.  The Part D plan enrollment will automatically disenroll them from the Medicare Advantage plan.  The new Part D coverage will begin on February 1st.  Whew!

The important lessons from this experience are:

1) People can drop their Medicare Advantage plan (MAPD) and go back to Medicare, but they need to enroll in a Part D plan to do this – and they should get a Medicare Supplement.

2) A Medicare Supplement application should be submitted at the beginning of the month so there is plenty of time for the paperwork to get processed.  Try to avoid being in the situation where you need to ask for the start date to be changed, as this also takes time.

For more information check out:  http://medicarechoicesofarizona.com

Some people think they are locked into their Medicare Advantage plan for the rest of the year.  This is not the case because they can make one change to another plan up until March 31st.  Here are changes that can be made between January and March 31.

If a person is in an MAPD (Medicare Advantage plan with a drug plan) they can: 
1) change to another MAPD plan
2) change to Original Medicare and get a stand-alone Part D plan

If a person is enrolled in an MA-only (a Medicare Advantage plan without a drug plan) they can:
1) change to another MA-only plan, or
2) go back to Original Medicare (but they can’t get a Part D plan at this time of year).

If a person has Original Medicare and a stand-alone Part D plan they can:  enroll in an MAPD plan (HMO, PPO por PFFS)

If a person has only Medicare (and no Part D plan) they can: enroll in an MA-only plan (with no drug plan)

The key constraint during this period relates to the Part D plan. If a person is enrolled in a stand-alone Part D plan they can’t change to a new stand-alone part D plan.  BUT, if they are enrolled in a stand-alone Part D plan, they can enroll in a Medicare Advantage plan that includes a Part D plan (thus changing their Part D plan).  Confused?  Don’t worry, you’re not alone. 

After April 1st no changes can be made to your Medicare coverage, whatever it is – unless you move out of the coverage area for your plan (Part D or Medicare Advantage). And if you move, you have only 63 days to sign up for a new plan or find yourself in limbo – where you are disenrolled from your old plan and you can’t enroll in a new one (until the end of the year).

Note:  Medicare Supplements can be changed at any time.  And people covered by AHCCCS and Medicare, or the people receiving a Low Income Subsidy for their drug plan can change their Medicare Advantage plan throughout the year.

For more information check out:  http://medicarechoicesofarizona.com

There’s an article in today’s Arizona Republic about doctors in Yavapai County turning away Medicare patients.   The reason is said to be a combination of too few doctors and low Medicare payments. The interesting point for Tucson residents appears in the following paragraph from the article:

The ratio of primary-care doctors to population is below the national average in all Arizona counties except Pima, Gila and Coconino counties. The situation is pronounced in Yavapai County, where one out of four residents is enrolled in Medicare, a rate nearly twice the national average. There, the ratio is 5.3 primary-care doctors for every 10,000 residents, below the national average of 10.5 per 10,000, according to a December 2009 St. Luke’s Health Initiatives report on primary care.

Tucson apparently has plenty of doctors and almost all take Medicare. Most doctors are also contracted with the Medicare Advantage HMOs, which have very large lists of primary care physicians and specialists in their networks.

I have heard complaints from a few doctor groups about the HMOs requiring prior authorization for tests. Doctors complain about the paperwork involved and refusals coming from the insurance companies. A recent story I heard was when a doctor requested an MRI for a patient with shoulder pain. The insurance company said “no” to the MRI and recommended physical therapy.  The patient contacted his insurance agent and said, “Get me out of this Medicare Advantage plan!”.

The big news in Benson is that Dr. Barbara Hartley is quitting Medicare Advantage HMO’s and only taking Medicare. The paperwork involved with the Medicare Advantage plans apparently takes up too much time for the doctor and her staff.

Here is the link to the Arizona Republic article: 

http://www.azcentral.com/arizonarepublic/news/articles/2010/01/24/20100124biz-medicaredocs0124.html