After March 31st, seniors enrolled in a Medicare Advantage plan will be “locked into” their plan for the rest of the year.  Enrollees can still change their Advantage plan until March 31st. They can also go back to using their Medicare card and enroll in a stand-alone Part D plan.  These changes must be done by March 31st.

I have heard stories of seniors switching to a new plan starting in January only to find the new plan requires more prior authorization paperwork, or refused an MRI that was requested by a doctor. One caller told me he only realized in March that his Advantage plan had dropped coverage for one of his prescription drugs. Fortunately, he was able to change to a plan that does cover his drug. If this had happened in April, he would have been stuck in a plan that did not work for him.

Here are plan changes that are allowed through March 31st:

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
3) change to a private-fee-for-service MA-only plan and get a stand-alone drug 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 or 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://arizonamedicarenews.com

Here is a concise summary of what the Health Care Reform Law means for Medicare and Medicare Advantage.  A change I haven’t mentioned previously concerns the time period for changing Medicare Advantage plans, which is currently allowed between November 15th and December 31st (with a focus on Part D) and January 1st to March 31st. 

Starting in 2011, people will get one period to change their Medicare Advantage plan or Part D plan between October 15th and December 7th. 

Medicare Advantage enrollees will be allowed to disenroll from their Advantage plan and go back to Medicare between January 1 and February 15th.  During this period, they would be allowed to enroll in a stand-alone Part D plan to replace the plan that was included in their Medicare Advantage plan (MAPD).

Here is the link to the very concise summary of changes for Medicare and Medicare Advantage:

http://www.medicarerights.org/pdf/Side-by-Side-Comparison-of-Health-Reform-Bills-Impact-on-Medicare-March2010.pdf

The big news is that there shouldn’t be big shocks for Medicare Advantage enrollees in November of this year.  And Democrats running for office won’t face the wrath of 11 million seniors – this election year.