In past years, people enrolled in Medicare Advantage plans had the months of January, February, and March to change to another Advantage plan.  That is no longer the case, and only one option is available to those who are unhappy with their Advantage plan.

Up until February 14th,  anyone enrolled in a Medicare Advantage plan can dis-enroll from their plan and return to Original Medicare. If the Advantage plan included a drug plan, they will be allowed to sign up for a stand-alone Part D plan to replace the drug coverage that was in their Medicare Advantage plan.

So, if a person has issues with their Medicare Advantage plan, now is the time to act, or be stuck with the plan for the rest of the year. Some people have discovered that their Medicare Advantage plan is not working for them for various reasons:

*The member’s doctor may have dropped the plan.

*The doctor network may be too restricted/small.

*Prior authorizations or referrals may be too cumbersome.

*Drug coverage in the plan may not suit the member’s needs.

These are issues that have arisen with certain Medicare Advantage plans in Arizona.

A person can enroll in a Medicare supplement at any time during the year – if they do not have medical conditions that disqualify them.

CAUTION! Before dropping your Medicare Advantage plan be sure you can get a Medicare supplement. With only Medicare and no supplement, a person who ends up in the hospital can run up big bills for doctor and surgeon costs (20% of each bill generated by any doctor who treats you or consults on your case). With just Medicare you will pay 20% of radiation and chemo treatment if diagnosed with cancer, and this could add up to $10,000 or more very quickly. Having only Medicare and no supplement can get very expensive if you get sick. So don’t make a rash decision about dropping your Medicare Advantage plan.

I had a phone call yesterday from a woman whose husband wants to change jobs, but the new employer doesn’t offer health insurance. I told her the safest route would be to apply for individual/family insurance before changing jobs so they’d be sure everyone in the family could get coverage before her husband quits his current job and loses his group plan.  Group plans are very different from individual or family health insurance plans.

I asked if everybody in the family is healthy and she said “yes”. We talked some more and she mentioned that her husband has Diabetes.  I said, “Whoa! Your husband is un-insurable with Diabetes!  No insurance company will take him.  Tell him he needs to keep his current job so he can keep his health insurance!”

The wife said, “But I thought the health care reform changed all that!” I told her that some of the health care and health insurance reforms have gone into effect already, but not that one. Her husband will have to wait until 2014 to be able to get individual health insurance with his pre-existing condition. I told her Republicans want to kill the bill and keep her husband from having more employment options.  Sounds like a “job-killing” plan to me!  I hope her husband doesn’t hate his current job.

Republicans want to repeal the 2010 Affordable Care Act which impacts a broad range of medical and health  insurance issues.  Many of the reforms are actually quite popular with the public.  Here are some changes that will affect Medicare beneficiaries in 2011.

Medicare will increase payments for primary care services by 10 percent. This increase applies to all fees for services provided by primary care physicians as well as nurses, nurse practitioners, and physician assistants.

Preventive health services, such as vaccinations and cancer screenings, will be covered for people on Original Medicare at no cost to the patient. Also, Medicare beneficiaries can now get a free annual “wellness exam” from their doctors.  Note:  People enrolled in Medicare Advantage plans have had these preventive and wellness benefits for many years. Medicare seems to have learned from the Medicare Advantage model which encourage seniors to get preventive screenings.

The Part D doughnut hole is being changed in 2011. Anyone who falls into the doughnut hole in 2011 will receive a 50% discount on their brand drugs while they are in the gap.  Generics will be discounted by 8%.  So a person whose brand drug costs are $500 per month would pay $250 instead.  This should provide serious relief to people who take expensive brand drugs.

Medicare Advantage plan payments from Medicare will be frozen at 2010 levels, so 2011 Advantage plans have not seen major changes to benefits. Actual reductions in what Medicare pays Advantage plans will begin in 2012, so we’ll have to wait and see what the plans will look like next year.

In the meantime, the Advantage plans will be working hard to upgrade their customer service so they qualify for bonus payments Medicare will offer to plans that get three or more stars on the Medicare.gov rating system.  People enrolled in Medicare Advantage plans can expect more attention from their plan this year, which might be a good thing.