If you are considering receiving your Medicare benefits from a Medicare Advantage plan in 2014 there are some important things you should be aware of.
Unfortunately, every year there are people who enroll in a plan that is not suitable for them.
Some people re-enroll in their current plan without reviewing any changes, others are misled by well intentioned family or friends, but most just fail to understand the rules and do proper research.
The rules that govern Medicare Advantage plans are very strict and choosing the wrong plan could leave you with a less than adequate plan for an entire year.
The following discussion while prepare you to choose the right 2014 Medicare Advantage plan for your budget and circumstances.
5 things to be aware of regarding Medicare Advantage
1. Know these important dates:
- If you are currently enrolled in a plan you will receive your Annual Notice of Change (ANOC) from your current plan in September. This details whether or not your plan is being renewed as well as any changes to the premium or benefits. Review this notice before you re-enroll in your current plan.
- 2014 Medicare Advantage plans will be available for review on October 1st. CMS guidelines prevent the release of plan information to the public prior to that date. In addition, plan sponsors and their agents are prohibited from marketing 2013 plans prior to October 1st.
- The time to submit an application is during the Annual Election Period which begins October 15th and continues through December 7th. You can submit more than one application during this time, but the last application received will cancel the others. Plans become effective on January 1st.
2. Here is where to find available plans:
- Visit medicare.gov and search for plans by entering your zip code. Keep in mind that only plan highlights are included and you should visit plan websites to get more information prior to enrollment.
- Compare plans online using interactive tools at PlanPrescriber. PlanPrescriber is the leading provider of unbiased comparison tools and educational materials for today’s Medicare-related insurance products.
- Speak with an insurance agent or attend a Medicare meeting in your area.
3. Understand the types of plans available.
The first distinction between Medicare Advantage plans is whether or not Part D drug coverage is included. Medical-only plans are referred to as MA plans. Medicare Advantage plans that include Part D are referred to as MAPD plans. There are several types of each plan.
- A popular type of Advantage plan is a HMO. A HMO typically is a MAPD plan. You must receive your services from a network provider (except in emergent situations) and often require a referral to see a specialist. If it it a MA plan, the Medicare guidelines will not allow you to add a stand-alone Part D plan.
- A PPO plan also has a network of providers, but you are able to go outside the network to receive service, normally at a higher cost. You cannot add Part D to a PPO MA plan.
- A HMO-POS is another type of HMO plan. POS refers to Point of Service and allows out-of-network coverage similar to a PPO. You cannot add Part D to a HMO-POS MA plan.
- A PFFS will allow you to use any provider that accepts Medicare and has agreed to accept the plan’s payment terms and conditions. You should be aware that providers can make that decision on a visit-by-visit basis. A stand-alone Part D plan can be added to a PFFS plan.
- Special Needs Plans SNP are a type of plan for certain segments of the Medicare population. There are plans for people who are enrolled in Medicare and have Medicaid benefits from their State (dual eligible), plans for people with certain chronic illnesses, and plans for people who are confined to a nursing home. These are coordinated care MAPD plans.
4. Cancelling a 2014 Medicare Advantage plan.
If you research your plan options, you should be able to enroll in a suitable plan and avoid cancellation altogether. But if you find that you have enrolled in a plan that is less than suitable, you do have a way out.
The Annual Dis-enrollment Period begins January 1st and continues through February 14th. During this time you can cancel your current plan and return to original Medicare. You are not allowed to enroll in another Medicare Advantage plan until the following years enrollment period. You can enroll in a stand-alone Part D plan and submit an application for a Medicare supplement if you choose, where you may be subject to medical underwriting.
5. Special Enrollment Periods.
You may be entitled to a Special Enrollment Period if you meet certain conditions. Some of the more popular enrollment periods include:
- LIS– If you receive extra help through low income subsidy related to your Part D coverage you are allowed to enroll in, switch or drop plans at any time during the year.
- If you move out of a plan’s service area you are granted a Special Enrollment Period.
- If you plan is not going to renew or is not available in your service area you qualify.
- 5 Star Special Enrollment Period – You are allowed to make on change to a 5 Star rated plan one time during the year.. Click Here to read more.
Unlike Part D plans which are offered Statewide, (See Part D Plans for All States Here) Medicare Advantage plans are offered County by County. If you live in a rural area you will typically have less choice than someone who lives in a more populated County.
When comparing plans, pay particular attention to these plan documents:
- Summary of Benefits
- Provider Directory
- Part D Formulary
Reviewing these plan documents will allow you to get a good idea as to the benefits and what your potential out-of-pocket costs may be. With this information you should be able to find the right plan.