Did you buy a Medicare Advantage Plan (MAPDI) during open enrollment this past fall? Have you tried to access care?

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I recently had a client call to say that her provider will not accept the MAPD plan in which she enrolled. At the time of her enrollment, I spent a great deal of time cautioning her about being sure that her providers accepted the plan. I was most concerned that the insurance company provider website might not accurately reflect the participating providers.

Further, I explain to all prospects that there is an out of pocket maximum exposure on these plans of up to $6700. This could end up being a huge surprise to someone who had been on a regular Plan F with effectively little or no out of pocket expense.

However, I can’t say I was totally surprised by the call. Often people are enticed by the lower premiums and the additional benefits that are advertised. As much as we try sometimes, prospects don’t really understand what we tell them.

If you enrolled in one of these plans with Anthem or United Health Care through AARP, you should have a new ID card by now. I strongly urge you to take that card to your doctors’ offices to verify that they do in fact, accept this plan, particularly if your provider is not a member of the Dignity Health Group.

I am sure that the office staff at the offices will hate me about now, but I believe it is very important that individuals understand the situation now, before it is too late in the year.

If it turns out this is not what you thought it was, there are a couple of ways out.

The Medicare website explains:

“If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you’ll have special rights under federal law to buy a Medigap policy and a Medicare Prescription Drug Plan if you return to Original Medicare within 12 months of joining the Medicare Advantage Plan.

If you had a Medigap policy before you joined, you may be able to get the same policy back if the company still sells it. If it isn’t available, you can buy another Medigap policy.

If you joined a Medicare Advantage Plan when you were first eligible for Medicare, you can choose from any Medigap policy within the first year of joining.” According to Kent Lewis, Market Manager for United Health care Medicare Solutions, UHC AARP actually allows two years for re-enrollment in a Medicare supplement.

Another way out is that during the first three months of the year, one can submit an application for a Part D Prescription Drug Plan (PDP). This will cause them to be dis-enrolled from the Medicare Advantage Plan and return to Original Medicare. However, this does not guarantee an option to enroll in a Medicare supplement plan. The criteria above must be met.

I want to be clear that I don’t think Medicare Advantage plans are “bad”. I simply want to be sure that consumers fully understand what they buy.

Folks on Medicare Advantage plans love the fact that they have one ID card and only have to deal with one vendor: the insurance company. They don’t have to understand Medicare, the supplement company and the Rx plan, while juggling 3 separate ID cards. They like some of the additional, albeit limited benefits.

As our President said, “Who knew healthcare was so complicated?” Well, the world of Medicare coverages can fall into that category. So proceed with caution and just be sure you understand what it is you purchased.

Margaret R. Beck
Margaret Beck  CLU, ChFC, CEBS started her insurance practice in Redding in 1978. As an insurance broker/consultant,  she represents businesses and individuals as their advocate.  She assists in choosing proper products, compliance with complex benefit laws and claims issues once coverage is placed. All information in her column is provided to the best of her knowledge, subject to final regulation by the respective agencies. Questions to be answered in this column can be submitted to info@insuranceredding.com. Beck's column is also published in the Redding Record Searchlight.
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4 Responses

  1. Avatar Bruce Vojtecky says:

    I have my new Medicare Advantage plan with Anthem and nervously wait to see the outcome. My first appointment is this Friday and so far they seem like they will accept the new/old plan. I’ll find out. I have been with Anthem for over twenty years and have been happy with them, I’ll find out Friday.

  2. Avatar Doug Cook says:

    Turning 65 in August and now just started thinking about the different plans. Thanks for the information.

  3. Avatar Richard Christoph says:

    Thank you for the excellent information, Marge. “Caveat Emptor” has never been more important in the world of healthcare, and your sage advice is invaluable and much appreciated.

  4. Avatar Rob Belgeri says:

    Is this MADP option now available in Shasta County, albeit with the negative provisions listed above? When I signed up @Fall 2018, I thought Medigap+Part D were all that was available here. Not certain a $6,700 out-of-pocket is worth Silver Sneakers.