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Health Reform 101

with Lisa Zamosky

WebMD helps readers understand their health insurance and the new health care reform law. The Affordable Care Act is bringing sweeping changes to American health care. Lisa Zamosky is here to help you navigate the health care maze and understand how these changes affect you.

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Thursday, October 6, 2011

Medicare Open Enrollment: Do I Have to Take Action?

By Lisa Zamosky

Tuesday’s blog started what will be an ongoing discussion here at the Health Insurance Navigator about the Medicare annual open enrollment period, which begins on October 15 and runs through December 7.

During open enrollment, Medicare beneficiaries have the opportunity to sign up for or make changes to an existing Medicare Advantage or Part D prescription drug plan, or to drop a Medicare Advantage plan and return to original Medicare.

Here’s a recent question that came to me about what, if any, action a Medicare beneficiary has to take during this period:

“MUST I enroll or re-enroll if I already have a Medicare Advantage or prescription drug plan and am happy with it?”

It’s Always Smart to Take Action

As I wrote in Tuesday’s post, it’s always a good idea to re-evaluate the plan you currently have to see what else is being offered for next year, even if you’re generally satisfied. It’s the only way to avoid being blindsided by changes in your plan’s features or provider network, for example, and to make sure your plan is offering the services you most need at the best possible price.

What’s more, says David Lipschutz, attorney with the Center for Medicare Advocacy, is that plans have the right to not renew their contract each year with Medicare. And Medicare can choose to not renew with a particular Medicare Advantage or Part D prescription plan as well.

“Some plans pull out, some consolidate or shift around and offer different versions of options,” Lipschutz says.

Plan Non-Renewal

If a plan pulls out of your market entirely, it must give you 90-day notice about the closure, your rights and what action you need to take.  You should have received that notice already.

In some cases, an individual insurance company with multiple plans will pull some of them off the market, but leave others, according to Lipschutz. “If I’m in Part D Gold Plan offered by ACME Insurance they will send a letter saying, ‘We’re pulling out of Gold and have permission from Medicare to put you in the Silver Plan unless you opt out,’” he says.

In such a scenario, if you don’t wish to be auto-enrolled in the alternative plan being offered, you’ll need to make an active change during open enrollment.

Special Enrollment Period

If your plan is not renewing, the government gives you a special enrollment period which extends the time you have to make decisions about your 2012 coverage. You have through December 31 to choose a new plan, which will start Jan. 1, 2012.

You can also wait to make a new selection until after your current plan has ended on December 31.  At that point, you have a 60-day period, or until the end of February 2012. 

If you take no action at all, you’ll be dropped from your Medicare Advantage plan and automatically enrolled in original Medicare. But you’ll be left without drug coverage, or a Part D plan, unless you sign yourself up for one by the end of February.  Miss that opportunity and you won’t have another chance to sign up for a plan until next year’s open enrollment.

SOURCES:

David Lipschutz, Center for Medicare Advocacy.

Center for Medicare Advocacy: “Annual Enrollment for Medicare Part C and Part D Plans.”

California Health Advocates: “When Medicare Advantage Plans Terminate Coverage.”

Posted by: Lisa Zamosky at 12:05 pm

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