I got a call on Monday, December 10th from Bob, who said he needs to change his Medicare Advantage plan. He said he has a problem with his current Medicare Advantage (MA) plan and wants to move to another MA plan. He said he knows the December 7th deadline for the Medicare Open Enrollment Period might make that impossible. I told him he is correct, so we had a discussion to see if he has any options.
Chronic illness Medicare Advantage plans
Medicare allows people to enroll in Medicare Advantage chronic illness plans throughout the year (but this “special enrollment period” is only allowed once per person).
Bob is in his late-70′s and has a variety of health issues. I asked him if he has chronic heart failure. The Medicare Advantage company he wants to change to has a special needs plan for people with this condition. If he has chronic heart failure, he could change to that special needs plan for a January 1st effective date. It turns out he has heart problems, but not chronic heart failure, a condition where the heart is too weak to pump sufficient blood flow throughout the body.
I asked Bob if he has Diabetes. The same company he wants to change to (because of its doctor network) has a special needs plan for people with Diabetes. He does not have Diabetes, so the chronic illness plan option will not work for him.
Medicare Advantage Disenrollment Period (MAPD)
Generally, people enrolled in a Medicare Advantage plan are “locked into” that plan for all of 2013. But Medicare came up with the MADP to give people an escape route if they realize (early in the new year) that they made a mistake by enrolling in Medicare Advantage. Medicare allows people to get out of their Medicare Advantage plan from January 1 to February 14. But, people need to think twice before making this move.
During the MADP, a person enrolled in a Medicare Advantage plan (MA) may disenroll from that MA plan and return to Original Medicare. But, they cannot switch to another Medicare Advantage plan. Their only option during this period is to go back to Original Medicare. Then they are allowed to enroll in a stand-alone Part D plan (PDP).
Medicare supplement companies can deny you coverage.
Anyone thinking about using the Medicare Advantage Disenrollment Period (MADP) must make sure they can get a Medicare supplement when they drop their Medicare Advantage plan. A person with health problems like Bob can be refused a Medicare supplement policy – and then they will have only Medicare.
Medicare alone is not very good coverage – especially if you have chronic health problems, are diagnosed with cancer, or have a serious illness that requires surgery and/or a lengthy hospital stay. People with only Medicare are responsible for 20% of their medical bills (beyond what Part A of Medicare covers), and that can add up to tens of thousands of dollars. There is no cap to this 20% co-insurance.
Bob and I reviewed the medical history questions on a Medicare supplement application. I told Bob that if he answered “yes” to any of them, he would be denied coverage. But… there are two companies I know of that will take him on… but….they will charge him a much higher premium.
I told Bob he could get a Plan F Medicare supplement for around $300 per month. If he were healthy, the same plan would cost him around $215 per month. Bob’s wife got on the phone and said $300 per month sounds pretty good to her.
So I will meet with Bob and his wife to explain the Plan F Medicare supplement, which will allow him to see any doctor who accepts Medicare. With Plan F, Bob will have no co-pays for medical services that are covered by Medicare. Medicare will pay first and the supplement will pay second, leaving him with no bills. Bob’s wife said she tracks his co-pays on his Medicare Advantage plan and they probably reach $300 per month when averaged throughout the year.
One more thing I almost forgot. Bob will need to get a Part D drug plan – and that will add $30 to his monthly premium costs. I’ll need to get a list of his prescriptions and do some research on his Part D options so I will have this ready when we meet next week.