Toni:
I have been on Medicare for almost 2 years; I need to change the Medicare Advantage Company I am in because 2 doctors I see are no longer accepting or part of my Medicare Advantage plan. Do I have to wait until a certain month of the year or can I change now….Sincerely, Eddie R, Houston, TX
Hello Eddie:
Generally, one cannot change their Medicare Advantage Plan until Annual Enrollment Period, also known as Annual Election Period or “AEP” as it is known in the insurance world. This year, AEP is from October 15-December 7th. So you are going to have to wait.
During the AEP you can:
1) Change from “Original Medicare to a Medicare Advantage Plan.
2) Change from your current Medicare Advantage Plan to a different Medicare Advantage Plan.
3) Change from your current Medicare Advantage Plan to “Original Medicare” with a Medicare Supplement (to help with the gaps that “Original Medicare” does not cover) and a standalone (Part D) Medicare Prescription Drug Plan.
4) Change from your current Medicare Advantage Plan to “Original Medicare” and a standalone (Part D) Medicare Prescription Drug Plan.
The above 4 options are for those who may not have “Special Needs” and Eddie, if you have “Special Needs”; then you can receive what is called a “SEP” (Special Election Period)
And can change your Medicare Advantage Plan, any time of the year. But you must have one of the SEPs to make a change outside of “AEP”.
I will explain both the Special Needs Plan or “SNP” and also the “SEP”. The “SNP” is a special Medicare Advantage plan which provides more specialized health care for specific groups, such as those on Medicare and Medicaid and those with chronic medical problems, such as diabetes, COPD, congestive heart failure, arthritis, etc. These plans give extra benefits, such as disease specific prescription drugs, which may be carried through the “donut hole”. If you have a special disease that qualifies you for a “SNP”, then this will give you a “SEP”. A “SEP” is a special time when you can join, switch or drop a Medicare Advantage plan at other times than during the Annual Enrollment Period (AEP). See page 77 of the 2012 Medicare and You handbook for more specific information about Special Need Medicare Advantage plans.
Not having your Doctors remaining in the Medicare Advantage Plan, which you have chosen is one of the down falls of the plans. Generally, a Medicare Advantage plan has yearly contracts with Doctors and any healthcare providers, but I have known plans to allow providers to opt out of the network with no warning. I would always check with the provider each year and make sure they are still accepting the plan that you are in. Also I would advise you to call your doctor or specialist and make sure that they are in the plan you want to enroll in. Many times providers are still in provider directories and they never asked to be in the plan’s network. Always double check to see that your provider is still accepting the plan!
Toni King is an advocate/consultant for those “Confused about Medicare”. Email questions to asktoni@medicaretruths.com or call 281/830-3896. Visit her website www.medicaretruths.com. *** I am seeking articles to write concerning healthcare reform and how it has impacted my readers. Please email me your situations or concerns….Thank you in advance and many blessings…Toni King
