Special Enrollment Period in Georgia and Tennessee

The Centers for Medicare & Medicaid Services recently announced a special enrollment period (SEP) for certain beneficiaries who reside in two states – Georgia and Tennessee. Both of these states have enacted legislation requiring Medicare supplement (also called Medigap) insurers to sell policies to Medicare beneficiaries under 65 – that is, those who have Medicare because they are disabled or have end stage renal disease. These Medicare supplement or Medigap policies are explained in chapter 11 of Managing Your Medicare.

Georgia has established a special open enrollment period for these individuals to buy a Medigap supplement policy effective from November 1, 2010 to May 1, 2011. In Tennessee, this runs from January 1, 2011 to June 30, 2011.

This Medicare special enrollment period is highly restrictive and is intended, solely for Medicare beneficiaries under age 65 who are now in a Medicare Advantage Plan, to be able to disenroll from their Plan, and, making use of this new state legislation, to go into Original (fee-for-service) Medicare with a Medigap supplement.

Medicare’s special enrollment period for these individuals is tailored to these states’ respective open enrollment periods. It will begin on February 15, 2011 (the day after the Medicare Advantage Annual Disenrollment Period ends, see my posting of January 4, 2011 on this) and will run to May 1, 2011 in Georgia and June 30, 2011 in Tennessee.

The special enrollment period allows a Medicare beneficiary under age 65 enrolled in a Medicare Advantage Plan to prospectively disenroll from that Plan and return to Original Medicare. Once the individual has Original Medicare, they will be eligible to purchase a Medigap supplement policy following their state’s Medigap open enrollment period guidelines. Disenrollment requests received by Medicare Advantage Plans are effective the first day of the month following the month the organization receives the request. Beneficiaries may not join or switch Medicare Advantage Plans under this special enrollment period. (You can disenroll by contacting your Plan or by calling 1-800-MEDICARE.)

Two important caveats. Technically, you can’t purchase a Medigap policy while you are in a Medicare Advantage Plan. That’s why Medicare says you must “prospectively disenroll.” One way around this is to see if your insurer will sell you the policy on the first day of your return to Original Medicare and make the policy effective with that day. Otherwise you face a period where you have no coverage for Medicare’s deductibles and coinsurances, which could be very expensive to you if you get seriously ill.

The other is that if you have Part D prescription drug coverage with your Medicare Advantage Plan, and you disenroll from your Plan, you will lose your Part D drug coverage unless you enroll in a stand-alone Part D drug plan. (Sometimes these are called a “PDP”.) Fortunately, this special enrollment period allows you to enroll in such a drug plan. Your enrollment will be effective with the first day of the month following the month you make your enrollment request. So you can keep your drug coverage without a break if you enroll in a drug plan the same month you give your disenrollment notice to your Medicare Advantage Plan. Be sure you do your homework ahead of time and find the best drug plan for you. And remember that if you happen to be in a Medicare Advantage Plan that requires no premium, you will have to pay a premium for a stand-alone drug plan.

If you do NOT have drug coverage at this time, you may NOT use this Special enrollment period to sign up for it. And if you have drug coverage with a stand-alone plan at this time, you may not disenroll from it or change plans. Only those that have drug coverage with their Medicare Advantage Plan and who disenroll from it can sign up for a stand-alone drug plan.

So if you are interested, you should contact your state department of insurance (for Georgia, this is the Office of Insurance and Safety Fire Commissioner, www.gainsurance.org or toll free1-800-656-2298; for Tennessee, it’s the Department of Commerce and Insurance, www.state.tn.us./commerce or toll-free 1-800-342-4029) and ask for information about Medigap policies for beneficiaries under age 65. Check out the benefits and premiums, and decide whether you want to go to Original Medicare with a Medigap supplement. And while most health care providers are willing to take beneficiaries who are insured with Original Medicare with a Medigap policy, you should always check with your providers to see if they do so before you make a change.

And, of course, don’t forget the deadlines of May 1, 2011 in Georgia and June 30, 2011 in Tennessee.