Not happy with your Medicare Advantage plan? CMS allows seniors to switch one time through March 31

Here’s some Medicare news you may have missed: Seniors who regret their Medicare Advantage choice for 2019 can make a one-time switch to another plan between now and March 31.

It’s just coincidence that the Centers for Medicare and Medicaid Services would offer a three-month extended Medicare Advantage open enrollment period nationwide this year. A year ago, those unhappy with their Medicare Advantage decision only had the option of switching to traditional Medicare coverage.

By now allowing people to move from one Medicare Advantage plan to another, beneficiaries have an opportunity to test drive the plan coverage to see if it lives up to the promises or, in some cases, the hype.

And it couldn’t have come at a better time for Western Pennsylvanians.

“Any time an individual has an additional period of time to reconsider a choice they’ve made, from my perspective, it’s a good thing,” said Bill McKendree, coordinator for the Allegheny County Apprise program that helps seniors select a Medicare plan.

That’s especially true this year when choosing a 2019 Medicare Advantage plan has been fraught with risk as Highmark and UPMC slug it out for market share heading toward their mid-year break up.

The Apprise staff has noticed the difference: In years past, Mr. McKendree said, seniors shopping for a Medicare plan would ask about monthly premiums, deductibles and co-payments. This year, they wanted to know if they can keep their doctor.

There are ways to avoid the great hospital network war, he noted. National insurers such as United Healthcare, Aetna and Humana contract with both health systems but not necessarily every physician.

His advice: “Do not rely on what brokers and marketers tell you. Reach out to each provider you want to hold onto and ask them” which insurance plans they will accept.

If in-network access is your top priority, he added, the best option may be original Medicare. Under the extended open enrollment period through March, CMS allows beneficiaries to switch from a Medicare Advantage plan to original Medicare within the first three months they’re in Medicare.

But doing that also would mean forgoing perks offered by most Medicare Advantage plans, such as maximum out-of-pocket costs, eye and dental care and gym memberships.

Brian Breisinger, president of MediConnect Insurance brokerage in Kennedy, says the extended open enrollment gives seniors a chance to reconsider their coverage in case they find out, for example, that a particular specialist isn’t in their network anymore.

“At the end of the day it’s going to be beneficial for the consumer.”

The extra three months should come in handy, too, given the confusing, even contradictory, information that circulated during the regular open enrollment period that ended Dec. 7.

UPMC has said its Pittsburgh and Erie hospitals, as well as most of its physicians, will be out-of-network for Highmark Medicare Advantage plan members after June 30, when the five-year consent decrees expire and the two sides are no longer contractually bound. So far, though, Highmark says it has not received the required 60-day termination notices from UPMC physicians.

In October, Highmark unveiled an enhanced out-of-network benefit for its Freedom Blue and Security Blue plans that will limit members’ out-of-pocket costs for care at UPMC.

UPMC countered that it will require all out-of-network patients to pay the estimated cost of their care upfront, making major procedures financially prohibitive for most people. Highmark has since hinted that it’s working to protect its members from laying out major cash pre-care but has not offered any details yet.

Meanwhile, each side has accused the other of misleading marketing messages.

Whether or not the next 90 days will be enough time for seniors to draw a clearer picture of their options remains to be seen.

As for the UPMC-Highmark battle, Mr. Bresinger sees UPMC gaining over the next three months based on the movement they saw to national insurers during the regular open enrollment period.

Mr. McKendree, though, said he believes the more successful party ultimately will be the one “who can deliver to the customer the promise of being able to accomplish two things: Access to the facilities and practitioners that they want and to do it in the most cost effective way.”


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