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.

The Tucson senior whose Medicare record was incorrectly changed to “deceased” received good news yesterday.  He got a call from a Medicare representative to inform him that his record had been corrected.  I was very impressed that Medicare, a bureaucracy with over 40 million members, called this man to apologize for the problem and let him know it had been fixed.

I have a feeling this Tucson citizen got some special attention because Congresswoman Gabrielle Gifford’s office got involved in his case.  On top of that, the Medicare Administrator put one of his aides on the case after I requested help last week during a conference call.  I’m not sure where the credit for the fix lies, but I am impressed by the quick action and efforts of Dan Frey in Congresswoman Gifford’s office and Peter Ashkenaz at Medicare headquarters in Washington, DC.

The problem for this Tucson senior arose when his wife died two months ago.  Because his wife was a housewife throughout her life, her Medicare number was her husband’s number with the letter B after it.  It is not hard to imagine that Social Security could make a mistake with this number that appeared in both the wife’s and her husband’s record.  Social Security changed the husband’s record to “deceased” and this information went to Medicare.

When this man went to enroll in a new Medicare Advantage plan, he was “denied due to death” by the company.  That happened a month ago and we went round and round trying to figure out how and when his Medicare record would get fixed.  I’m happy to report that this man also was informed yesterday that he is enrolled in a new Medicare Advantage plan for January 1.

Medicare beneficiaries have until the end of December to make changes to their Medicare coverage if they are thinking about moving to another Medicare Advantage plan or stand-alone Part D drug plan.  Folks who have only Medicare and no supplement may want to consider their options among Medicare Advantage plans and Medicare supplements.  But everyone must make changes before December 31st.

Medicare supplements can be purchased at any time of the year, but Part D plan enrollment is only allowed between November 15 and December 31 (unless a person is new to Medicare, moving to a new state, or has a low income subsidy for drug costs).

In past years, Medicare beneficiaries had the “Open Enrollment Period” of January through March, during which they could change to another Medicare Advantage plan.  That change period is no longer available, so everyone will be “locked into” their Medicare Advantage plan for all of 2011 as of January 1.

There is a new “dis-enrollment period” for Medicare Advantage which runs from January 1 to February 14th.  If a person decides in January that he doesn’t like his Medicare Advantage plan, he can dis-enroll from that plan, return to Original Medicare, and get a stand-alone Part D drug plan.

A trend among people I am dealing with is to move from Medicare Advantage back to Medicare and purchase a Medicare supplement.  When turning 65, many healthy people choose to enroll in a Medicare Advantage plan because of the $0 monthly premium and inclusion of Part D in the plan. But I’ve been talking to people, some who are healthy and some who are not, who have decided they want to get a Medicare supplement while they can.  They have decided they would prefer to pay in advance for complete (or nearly complete coverage) they get with a Medicare supplement rather than the pay-as-you-go system of Medicare Advantage.

Medicare gives people a one-year trial period for Medicare Advantage, after which a person can return to Medicare and get a Medicare supplement without answering medical questions.

One Medicare supplement company offers a two-year Medicare Advantage trial period and will accept a person for their Med Supp even if they have health issues.

Another company is taking applications for it Plan N Med Supp with no medical questions asked.  I have warned my clients that this option – if it is their only Medicare supplement option  – should be considered with the understanding that the premium for this Plan N will likely shoot up quickly and substantially.  This is because everyone enrolling in this plan is likely to have health issues which will cause the company to have high claims costs.

People who are happy with their current Medicare coverage don’t need to do anything. Their Medicare Advantage plan coverage, Medicare Supplement, or Part D coverage will roll over for 2011.

There are quite a few people who are enrolled in plans that are being canceled or are changing substantially.  Anyone enrolled in a private-fee-for-service plan (PFFS) should look closely at their plan costs and coverage. Many of these plans are being canceled and people enrolled in them received a letter announcing this in October.

One PFFS plan remains, but is as expensive as a Med Supp plan, and yet this PFFS plan has lots of co-pays.  PFFS plans in outlying areas of the state may be the only Medicare Advantage option for people in places like Yuma and Safford, so they may offer some value even if their premium is much higher than plans offered in urban areas.

Health Net’s Amber plan is changing to a “dual-eligible” AHCCCS/Medicaid plan only.  I have heard that Health Net has finally sent a letter to people enrolled in this plan who are not “full dual” to inform them that they must change to another plan.  These are people whose co-pays are not covered by AHCCCS (Arizona’s Medicaid). They will be shocked to see the co-pays in the “regular” Medicare Advantage plans that are double and triple what they paid through the Amber plan.