MedBillsAssist Blogs

According to Medicare (Center for Medicare and Medicaid Services- CMS)  approximately 7% of beneficiaries enrolled in Medicare Advantage (MA) plans will have to choose a new health plan or rejoin original Medicare before December 31. This change will take place, because many of the current private Medicare plans did not renewed its contract.
If members of this group do nothing they will be automatically re-enrolled to traditional Medicare, without supplemental and prescription coverage.

CMS is responsible with providing Medicare beneficiaries the information they need to make informed choices. This includes general information to remind beneficiaries that a Medicare Advantage plan may choose not to renew its contract with Medicare.
The obligation to provide direct and specific information about the nonrenewal to plan enrollees falls on the MA organization (specific insurance company) that sponsors a plan whose contract it does not intend to renew. The MA organization must provide plan enrollees with a notice 90 days before the end of the year. The notice must include a written description of alternatives available for obtaining Medicare services within the service area, including alternative MA plans, Medigap options, and original Medicare. The MA organization must also provide notice to the public within the same period, generally through publication in a newspaper in the community it will no longer serve.

Because notification regulations were developed before enactment of Medicare Part D (PDP) , they do not specifically require non-renewing plans to include information in their notice to enrollees about prescription drug coverage. As a result, beneficiaries may not receive sufficient explanation of the need to enroll in a PDP by December 31, 2009. Most beneficiaries who return to original Medicare and who do not choose a drug plan will find themselves without prescription drug coverage in the New Year.

Despite rules that are intended to protect enrollees in private Medicare plans that are not renewing their contracts, beneficiaries still bear the burden of ensuring that they have complete health care coverage. Those who do not choose another MA plan will have original Medicare, Parts A and B, to provide for most of their health care needs. However, they will not have prescription drug coverage unless they take affirmative action to choose a PDP. They also may want a Medigap policy to assist with Medicare’s cost sharing.

6 Responses to “Critical Update for Medicare Advantage Members”