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Making a switch? It can be complicated |
This is a spot where no consumer wants to be — feeling trapped in one’s medical insurance coverage. That’s the unhappy bind in which increasing numbers of seniors find themselves, according to media accounts, which are focusing on discontent with Medicare Advantage plans. Caveat emptor, folks. Make those Medicare decisions carefully and with due diligence starting at age 65. If patients eventually want to change plans, it can get messy and complicated. Both original Medicare and Advantage programs have open periods annually when most customers can make changes. For original Medicare, open enrollment runs from mid-October to early December. It is different for Advantage plans, whose open periods span Jan. 1 to March 31. Patients unhappy in Medicare Advantage, experts say, likely will find smoother going if they switch to another Advantage plan In a five-year span scrutinized by one researcher, half of those studied and in Advantage plans switched. Experts are digging deeper to see how much discontent is reflected in that metric. Recent news articles say consumer unhappiness is driving Advantage customers to want to change over to original Medicare. The disgruntled complain that as they have grown older and sicker and need more and specialized care, the Advantage plans don’t fill their needs. They grow weary over constant battles over approvals and denials of treatments their trusted doctors recommend. They say they feel gulled by their earlier choice for Advantage plans, which they find deceiving in their seemingly favorable costs and benefits. But it’s not easy to switch back to original Medicare after patients make an initial Advantage choice at age 65, and a big part of the complication is due to later issues with Medigap plans. At the outset and for six or so months after, those picking original Medicare can seek gap plans and insurers cannot deny them coverage based on preexisting conditions, and companies are limited in premium increases (adjustments) for these enrollees. But those who pick Advantage plans, then want to switch to original Medicare later, mostly lose the preexisting condition protections in gap coverage. They may find it harder to find suitable gap plans and may pay hefty charges accordingly. Those who have original plans and then switch to Advantage should be advised that they, too, will give up their gap coverages and preexisting condition protections. This can make it difficult for them to return to original Medicare. Those switching from Advantage to original plans should carefully calculate the costs for their change. Besides determining (in advance, please) what they might pay for gap coverage, they also may want to add a prescription drug plan, determining which of their medications qualify in which plans. While making important coverage decisions, consumers may consult federal ratings — rankings using stars — for help. As the Wall Street Journal reported, however: “The government tries to help reduce the complexity of Medicare choices with its star ratings of plans, but research has shown that high star ratings do not tell us whether a plan will improve our survival or not. This makes choosing a plan in Medicare very hard to understand and manage. It’s even harder for people who have dementia, or are in a nursing home, or both. All this information means more work. But ensuring you’re properly protecting your health — and your pocketbook — is worth the effort.” |
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