A number of Medicare beneficiaries have received a notice from their Medicare Advantage Plan that their current Plan is leaving the Medicare program on January 1, or that it will no longer serve the area the beneficiary lives in, effective with that date. (These are called, respectively, a “nonrenewal” and a “service area reduction.”)
As I point out on page 126 (“Nonrenewals”) of Managing Your Medicare, a special election period (these are also called “special enrollment periods” and are often abbreviated SEP) exists for members of Medicare Advantage (MA) plans that are affected by a nonrenewal or service area reduction effective January 1.
For beneficiaries currently affected by this, your special election period began October 1, 2010, and ends next year, on January 31, 2011.
As noted in the book, your current Medicare Advantage Plan must send you a detailed notice about what your options are, and the deadlines imposed on you. The Centers for Medicare & Medicaid Services (CMS) supervises these notices quite closely, and they are fairly comprehensible, but it’s important to clearly understand them and to know what your several options are.
These are your options:
You may choose to go into another Medicare Advantage Plan with Part D drug coverage. Or you may join one without drug coverage AND also join a stand-alone Part D drug plan. Or you may join one without drug coverage and NOT join a stand-alone Part D drug plan.
You may take any of the three options above whether or not you currently have any Part D drug coverage.
OR
You can go into Original (fee-for-service) Medicare, and, if you wish, join a stand-alone Part D drug plan. And you can do this whether or not you were ever in Original Medicare, or whether you do or don’t currently have Part D drug coverage.
The effective date will depend on what choice you make. If you enroll in another Medicare Advantage Plan, your enrollment will be effective January 1 if the Plan you choose receives your request before that date. If it receives your request in January, it will be effective February 1, 2011.
The same is true if you enroll in a stand-alone Part D drug plan. If you enroll in one of these, your enrollment will be effective January 1 if they receive the request before that date. If they receive your request in January, it will be effective February 1, 2011.
If you do not sign up for another Medicare Advantage Plan, you will automatically be put in Original Medicare effective January 1. If you had drug coverage with your Medicare Advantage Plan, you will no longer have drug coverage unless you sign up for a stand-alone Part D plan. The exception to this is that if you have extra help (the low income subsidy, sometimes abbreviated LIS), and you don’t sign up with a drug plan, Medicare will automatically enroll you in one.
For those beneficiaries who are 65 years of age or older, and decide to go back to Original Medicare, you will get a special federal right to buy a Medigap policy. These special rights are sometimes called “Medigap protections” or “guarantee issue rights.” (And for those of you who are not 65 years of age or older, your state may require Medigap insurers to sell you a policy; check with your state insurance commissioner.)
Beneficiaries who are 65 years of age or older and go back to Original Medicare have only until March 4, 2011, to purchase a Medigap policy using their guarantee issue rights. (This is the standard 63 days from when you loose your coverage from your Medicare Advantage Plan) Specifically, any company that offers a Medigap policy of type A, B, C, F-High, F-Low, K or L in your area has to sell you one. That is, the company (1) must sell you a policy, (2) it must cover your pre-existing conditions, and (3) it cannot charge you more because any past or current health problems you may have had or have.
And remember that if you go into Original Medicare effective January 1, your SEP continues until the end of that month. You still have the option of signing up with a Medicare Advantage Plan with or without drug coverage. And if you decide to stay in Original Medicare, or if you sign you with a Medicare Advantage Plan that does NOT have drug coverage, you may still use your SEP to join a stand-alone Part D drug plan. The effective dates for these actions will be February 1, 2011. And remember that, if you decide to stay in Original Medicare, your deadline to get a Medigap policy continues to be March 4.
You notice from your Plan will also tell you that there are some other special Medigap protections which apply to you (1) if you are age 65 or older and got Part B within the last six months, or (2) if in the last 12 months (sometimes up to 24 months) you dropped a Medigap policy to join a Medicare Advantage Plan for the very first time; or, (3) if in the last 12 months (sometimes up to 24 months) you joined a Plan when you were first eligible for Part A at age 65. (These are covered in detail in items 8.1, 8.2.4 and 8.2.5 of the book.) These may permit you to buy a policy other than type A, B, C, F-High, F-Low, K or L, that is, type D, M or N.
There is also one other special right that comes if you are affected by your Medicare Advantage Plan’s nonrenewal or service area reduction. If you are one of the few beneficiaries who have End Stage Renal Disease and are in one of these Medicare Advantage Plans, you get a one-time right to join a Medicare Advantage Plan. You may exercise this right at this point in time, or you may hold it and use it in the future. But you have only a ONE-time right, and remember that otherwise, in general, beneficiaries of any age with this disease cannot join a Medicare Advantage Plan, so use this special right carefully.
By the way, there is some confusion as to the proper effective date. This is simply because in the past CMS has allowed the effective date, at the beneficiary’s choice, to be the first of the month immediately following the month the beneficiary files their enrollment request. (So, for example, if you filed it in November, you could choose December 1.) This, however, has changed for this year; the effective date can only be January 1 or February 1, depending only on when the request is received by the Medicare Advantage Plan and/or stand-alone drug plan you are joining. This probably makes more sense as if you went into Original Medicare or a new Plan on December 1, you would again have to meet all the applicable deductibles for calendar year 2010, and then have to do this all over again beginning in 2011.
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