The open enrollment for Medicare Advantage plans begins Jan. 1. (Wix file photo)
K-State Research and Extension News
Submitted by Kathy Goul, Family & Consumer Science Agent
Each year I am asked why, after Medicare open enrollment ends in December, that advertisements for Medicare plans have returned to our television screens and mailboxes after the first of the year. The simple answer is because January 1 – March 31 is the Medicare Advantage Plan Open Enrollment Period.
Understanding what you can and cannot do during this period is the part that, often times, can be confusing. The most important thing to remember, is this enrollment period only applies to individuals currently enrolled in a Medicare Advantage Plan.
Two options are available during this enrollment window. One option is to choose a different Medicare Advantage Plan. An individual may choose this option for a variety of reasons such as a doctor leaving the network, out-of-pocket costs increase, a deductible has been added to prescription drug coverage, or poor customer service. It is important to note this option is a one-time use.
Once you choose a new plan, the Medicare Advantage Plan Open Enrollment Period ends. You cannot choose a new plan each month. Coverage under the new plan begins the first of the month following enrollment in the plan.
The second option available is to leave a Medicare Advantage Plan and return to Original Medicare. This option involves more steps and should be planned out well before leaving the Medicare Advantage Plan, to ensure you will not be surprised by large out-of-pocket expenses.
Original Medicare refers to Medicare Part A and Part B only. If you choose this option, you must enroll in a Medicare Part D Prescription Drug Plan. If you do not have “credible” prescription drug coverage from another source, you will be subject to late enrollment penalties when you join a plan down the road.
If you do not currently take prescription medications, there are two Part D plans this year in Kansas that have a $0.00 monthly premium. I like to refer to these plans as your “get out of jail free” card. If you sign up for one of these plans, you have no up-front, out-of-pocket costs and will not be subject to a late enrollment penalty. Your Part D coverage will begin the first of the month following enrollment in the plan.
The most important part of switching back to Original Medicare is understanding that with only Medicare Part A & B, you do not have an out-of-pocket maximum that you would pay in any given year.
A simple way to explain this involves looking at the cost sharing on Medicare Part B. Medicare picks up 80% of our bill and we pay $20% (after the annual deductible). This could be 20% of $100, $10,000 or $100,000. Reducing our financial risk with Original Medicare involves adding a Medicare Supplement (Medigap) Plan.
This provides the most comprehensive coverage by picking up all, or most of, what Medicare Part A & B are not paying.Beneficiaries choosing to return to Original Medicare do not get a guaranteed issue period.
Unless you qualify for a special enrollment window, you will be subject to medical underwriting.This involves the insurance company asking you about current and previous health concerns to determine if they want you to enroll in their plan.
Based on your response, the company can choose to accept or deny you coverage. If you are accepted into the plan, you will want to make sure the plan starts coverage the first of the month following disenrollment in your Medicare Advantage Plan.
When making changes during this open enrollment period, I suggest individuals work with independent insurance agents, who represent more than one carrier, to assist with selecting and enrolling in new plans. This is especially important for those leaving a Medicare Advantage Plan and returning to Original Medicare.
For more information about the Medicare Advantage Plan Open Enrollment Period, please call our Paola office at 913-294-4306.
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