FOR IMMEDIATE RELEASE
Contact: Paul Precht
Director of Policy and Communications
Deputy Director of Communications
March 4, 2010
Last Chance to Change Medicare Health Plans
-- Most People with Medicare Will Be Locked In on April 1 --
New York, NY—People with Medicare have one last chance to change their Medicare health plan before they are locked into their plan for the rest of 2010.
During the Open Enrollment Period, which began January 1 and lasts through March 31, people with Medicare are allowed to change their choice of Medicare health coverage once. They cannot, however, add or drop the Medicare drug benefit (Part D), and they cannot switch from one stand-alone prescription drug plan to another. Most people with Medicare will not be able to change their health plan again until 2011.
For example, a person who is enrolled in a Medicare private health plan (also known as a Medicare Advantage plan or, in some cases, a Medicare HMO) with drug coverage can switch to another that also offers drug coverage, but not to one that does not offer drug coverage. They can also switch to Original Medicare and buy a stand-alone drug plan. If someone has Original Medicare with a stand-alone drug plan, they can switch to a Medicare private health plan with drug coverage. They cannot, however, stay in Original Medicare and change only their stand-alone drug plan, as this would be considered a Medicare drug coverage change, not a health coverage change.
“Changing how you receive your Medicare health benefits is not simply a matter of changing to a plan with a cheaper premium,” said Joe Baker, president of the Medicare Rights Center. “Switching plans can change which doctors you are allowed to see, access to benefits you may need as well as the cost of your care. And since you are allowed to make just one change, be sure you understand how the new plan works before signing up. Ask questions, or call us or your local State Health Insurance Assistance Program (SHIP) for help. Don’t let a salesperson use the March 31 deadline to pressure you into signing up for a plan.”
SHIPs are federally funded programs that are available in every state; they provide answers to Medicare questions free of charge.
A person who is considering a Medicare private health plan, like a Medicare HMO, should ask a number of questions before enrolling, including:
A full list of helpful questions is available on Medicare Interactive.
- Will I be able to use my doctors? Are they in the plan’s network and are they taking new patients who have this plan?
- Are my prescription drugs on the plan’s formulary (list of covered drugs)?
- Does the plan require that I get “prior authorization” before my prescription will be covered, or impose other restrictions (like limiting the quantity or requiring that I try a cheaper medication before it will cover a more expensive one)?
- How much is my monthly premium?
- Is there an annual out-of-pocket maximum? (After I spend a certain amount on medical services, will the plan cover all my copays?) Are all services included in the out-of-pocket maximum?
- What service area does the plan cover?
Consumers who decide to change plans should do so by enrolling in the new plan. This will automatically disenroll them from the old plan. (Disenrolling from one plan and enrolling in another count as two changes, which is not allowed.)
Medicare consumers who have coverage from a former employer should be aware that signing up for a Medicare private health plan can sometimes cause permanent loss of that coverage. They should always check with the company that provides their retiree coverage before enrolling in a Medicare private health plan.
Consumers should also know that a Medicare private health plan will not work with their supplemental “Medigap” plan as it does with Original Medicare. Medigaps supplement Original Medicare only. People who have Original Medicare with a Medigap and are considering switching to a Medicare private health plan should be aware that in certain states and situations, they may not be able to get their Medigap policy back, or may have to pay a higher premium if they have a history of illness. Rules about purchasing Medigap policies differ from state to state, and consumers are advised to use the resources mentioned below to learn their state’s rules before making a switch.
Under certain circumstances, people may be eligible for a special enrollment period to change health or drug plans. For example, people who were misled into enrolling in a Medicare private health plan qualify for a special enrollment period.
Medicare consumers have several free resources to help them make the right decision for their needs:
- The Medicare Rights Center offers free resources for people who want to learn more about Medicare private health plans. Medicare Interactive, a free, web-based counseling tool, is available at www.medicareinteractive.org. People who prefer to speak with a counselor can do so by calling the toll-free hotline at 1-800-333-4114. Counselors are available Monday through Friday, 9:00 am to 5:00 pm (Eastern Time).
- State Health Insurance Assistance Programs (SHIPs) also offer free guidance. Consumers can find their local SHIP office by calling 1-800-677-1116.
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Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives.
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