Medicare Advantage Disenrollment Period: Having Second Thoughts?

January 1 through February 14 is the annual Medicare Advantage Disenrollment Period, also known as the MADP.  This time of the year is strictly for folks who have a Medicare Advantage Plan (MAPD) and wish to drop it and revert back to Original Medicare.

If you’re like most people and you’re satisfied with your Medicare Advantage plan and all is well in the world.   By now, you should have received your ID cards in the mail and probably filled some prescriptions and all is well.  But…

If all is NOT well, or if  you’ve had some unexpected changes to either your health or your healthcare providers, this time during the year may become more important to you.  As an example, let’s say you just opened your mail and opened a letter from your beloved that your primary care physician is moving out of the plan’s network.  Could be one of your necessary prescriptions disappeared from your plan’s formulary.  If you want to go back to Original Medicare at this point (A and B) you can, and you also have to enroll in a stand-alone Medicare PDP plan, too.

Essentially, for whatever reason you choose, if you have an MAPD plan, during this timeframe you can drop it, no questions asked.  Any other time during the year you generally have to keep it.  The same time period does NOT apply to those already on Original Medicare, or those with Medicare Supplements.

To enact your rights during the Medicare Advantage Disenrollment Period, you can contact your current plan or get in touch with the folks at Medicare by calling 1-800-MEDICARE.  Your disenrollment will occur as of the first day of the month following its acceptance and at that time you will be back on Original Medicare only.  Again, you will want to pick up a PDP plan so you have prescription drug coverage and might also want to consider picking up a Supplement, also referred to as Medigap.  Check Medicare.gov to see which companies offer Supplements in your area.  Each company offers the same Supplements as their benefits are dictated by the state but each private insurance company prices the product differently.  You can compare all the plans prices at Medicare.gov.

Before you go dropping your Medicare Advantage plan , it’s important to remember you are absolutely not guaranteed enrollment in most Medicare Supplement policies unless it’s during your 6 month Open Enrollment Period that takes place when you turn 65 and/or when you enroll in Medicare Part B, whichever happens last. During this time, you have guaranteed acceptance and the insurance company cannot turn you down based on preexisting conditions and they also cannot make you wait for any treatment that was prescribed prior to your enrollment.  Which means if you’re not in your OEP that there is the possibility that you won’t be able to medically qualify for a Supplement.  If this happens, you’ll l remain on Original Medicare.   only until the fall when the next AEP rolls around.  Make sure that this is an acceptable outcome to you prior to dis-enrolling from your current plan.

The Takeaway:

Medicare Advantage Disenrollment Period can be a benefit to exercise if you’re dissatisfied with your current MAPD plan.  It can allow you to leave a plan that is not a good fit for you.  Just make sure you’re aware of the implications of doing so and are content with the benefits offered by Original Medicare.  Also be sure to pick up that Prescription Drug Plan if you don’t want to pay a late enrollment penalty down the road.

 

 

Medicare Sales Scope of Appointment

Medicare’s Annual Election Period (AEP) is just days away. This is a very busy time for insurance sales agents, who are filling their calendars with sales appointments. But before they can sell you a plan, they must secure Scope of Appointment documents from YOU, the consumer.

If you call an insurance company or an insurance agency and request to meet with an agent, they’ll typically offer an appointment in your home, or at a library or coffee shop. But before you meet with a sales agent to discuss your plan options, every one of them will require you to fill out a Scope of Appointment.

The Scope of the Appointment outlines what you specifically want to discuss at the appointment whether it is a Part D plan, a Medicare Advantage Plan, or a Medigap plan. The agent is not allowed to talk to you about products that are not included in the scope of the appointment.
When the agent presents you the Scope of Appointment, typically they’ll want you to agree to discuss ALL plan options, which is usually a good idea. That’s because if you think you’re in the market for an MAPD plan, but it turns out you want a Medicare Supplement (Medigap), there’s a problem.  If you didn’t fill out the Scope of Appointment form to ‘OK’ talking about a Medigap plan, then the agent cannot talk to you about it.

Scope of Appointment Not Always Required

The Scope of Appointment form is not required during sales and marketing seminars. So, if you get invited to and attend a seminar to listen to Medicare options, and decide to buy a product at the end of the seminar, you won’t need one.

Scope of Appointment forms often differ from one health insurance plan to another. The form usually indicates the sales agent does not work for the federal government and may benefit from the sale of the health product (will receive a commission).
The forms also bear the notice that signing the appointment form is not a binding agreement to enroll in any plan. The form does not affect your current or future enrollment status in any Medicare plan.

By law, it is not possible for any insurance sales agent to proceed with an in-person appointment unless the beneficiary or the person seeking information on their behalf has signed and submitted the form to the agent.
During the in-person appointment, the following are the actions that the sales agent is legally allowed to make:
1) They can discuss various plan options with you
2) They can distribute plan materials, including the enrollment kit for the insurance product
3) They can distribute or collect enrollment forms
4) They can advise on how to get plan information, for example through mail, a website or customer service
5) They can also provide educational content

However, the sales agent cannot market non-healthcare related products until at least 48 hours after the original appointment.

The Takeaway:

The Medicare Scope of Appointment is a form you must fill out before an insurance agent can discuss plan options with you.  It’s best to fill it out completely, marking all of the Medicare plan options you may wish to discuss.

You Must Read Your Medicare ANOC (Annual Notice of Change)

If you have a Medicare Advantage plan or a Medicare Part D plan, it’s very important you read at least a portion of the Annual Notice of Change (ANOC) your insurance company sends you.  This will usually arrive in your mailbox in a large, intimidating package with your insurance company logo affixed in the upper left-hand corner.  Medicare insurance companies are bound by regulation to have this delivered and in your hands by September 30 of each year.  Please resist the temptation to throw this in the recycling bin, or stash it near the phone in the, “I’ll get to it later” pile!

Here’s why:  The AEP (Annual Election Period) is coming on October 15, and ends on December 7.  If you don’t read your ANOC before then, you won’t know what changes are being made to your plan until they go into effect on January 1!  By that time, it’s too late to make a change for an entire year if you want to pick a new Medicare Advantage or PDP plan.

The bad news:  It can be a thick, heavy document.  It’s also in black and white, and very boring and bland.
The good news:  I’m not asking you to read the whole thing, just the important parts.  What are the important parts? Immediately go the section entitled, “Summary of Important Costs 2017.”  It should be right up front, either page 2 or 3.

Medicare ANOC
Medicare ANOC Sample

Your Benefits Change Every Year

I’ve never seen a Medicare Advantage plan NOT change at least SOMETHING from one year to the next.  Same goes for PDP plans.  Almost every plan makes some changes for the new year, so the costs and benefits in place on December 31 may very different on January 1. Here are some changes that can really throw you for a loop!

You May Have a Premium!

Surprise!  If you had a $0 Medicare Advantage premium, that may have changed! Every year thousands of people get surprised in this way, all because they do not read their ANOC and only realize this when they either get a bill, or notice a new deduction from their Social Security checks in January or February.

Your Premium May Be Going Up!

The ANOC is where (and when) Medicare insurance companies announce you’re going to have to pay more (or not) in the upcoming year for your PDP or Medicare Advantage Plan

Your Plan May Be Disappearing

This happens all the time.  Sometimes insurance companies stop offering certain plans.  This is usually because they can’t make money in that area, don’t have enough willing doctors, physicians or pharmacies to participate in their plans.  Sometimes, plans go out of business or are terminated by Medicare.

Other ANOC Changes to Watch Out For

The plan may change its charges for premiums, deductibles, and copays.

Your very important Maximum-out-of-Pocket (MOOP) may be increasing! The maximum MOOP for Medicare Advantage plans for 2017 remains at $6,700 annually, not including Medicare Part D costs.

Your Medicare Advantage or PDP plan may move drugs to different tiers so the copays change.

The plan may alter its formulary (the list of drugs it covers) by dropping some drugs or adding others.  They can also do this at any time during the year.

For other changes, the plan must send you details in an ANOC.

The Takeaway:

The Annual Notice of Change (ANOC) is a document listing any changes in plan coverage, service area, or costs that will go into effect the following January. All Medicare plans are required to send this to plan members by September 30, or 15 days before the start of the Annual Election Period.

You should review at least the Summary of Changes in your ANOC Annual Notice of Change especially if you’re worried about whether or not your medications are still included in the plan’s drug formulary (the list of prescription drugs covered by the plan). If a drug you take is no longer covered, you may want to consider switching to a different Medicare prescription drug plan.

If you have a Medicare Advantage plan and notice your out of pocket costs going up, it’s a good idea to shop and compare your current coverage against other Medicare Advantage plans during the Annual Election Period. 

If you haven’t received the Annual Notice of Change by the end of September, you should contact your Medicare plan to request it.

Remember to read your ANOC (or, at least some of it)!  If you miss making a new plan choice during the AEP, you’re basically locked in for the next year, unless you qualify for a Special Election Period (which you shouldn’t count on).