Medicare Moments: Buyer’s Remorse
Recorded: November 18, 2011
Narration: Welcome to Fairfax County’s Medicare Moments, the podcast that brings you the latest information on Medicare benefits. I‘m your host Jim Person, as you all know the open enrollment period to make changes to your Medicare benefit plan for the 2012 season was from October 15 to December 7. Some of you probably decided to sign up for the Medicare Advantage plan to save money, but now you have buyer’s remorse. On today’s show, we will be discussing the difference between original Medicare and Medicare Advantage and your options if the Medicare Advantage Plan isn’t the right fit for you.
Jim: Joining us today to discuss Medicare Advantage is Howard Houghton, manager of Fairfax County’s Virginia Insurance Counseling and Assistance Program. Welcome, Howard.
Howard: Hi Jim
Jim: Medicare Advantage, Howard, has been an option for Medicare recipients for some time now. What’s the difference between Original Medicare and Medicare Advantage?
Howard: Well Jim, the basic difference is that original Medicare has been around for many years and Medicare Advantage is relatively new.
Under original Medicare, you could be cared for by just about any medical provider who accepts Medicare nationwide. You can go to practically any hospital nationwide and you don’t need referrals to visit specialists and you can reasonably predict your expenses throughout the year.
Under Medicare Advantage, you will usually need to be cared for only by doctors in their health plan network or by one who might accept the plan and there is a strong likelihood you would need to change doctors. You may also need to determine which hospitals or labs are in that new network and often times it’s difficult to predict your out-of-pocket costs. Such plans usually have less flexibility than original Medicare.
Jim: Can you give us an example of why someone would think “Oh no I made mistake!” regarding their Medicare Advantage program.
Howard: Well, sadly we see that happen all too often. Our experiences are that many persons do not understand the constraints under these Medicare Advantage plans. Many of them have a limited number of physicians that accept the plans. Several of the plans have some higher drug costs because their premiums are less.
Jim: Okay, so open enrollment is closed and a Medicare beneficiary realizes they made a big mistake by choosing the Medicare Advantage Plan. Is there any way they can make the change back to original Medicare without having to wait until next year?
Howard: Well, fortunately as part of the Affordable Care Act beginning this year 2011 and extending into 2012, if a person believes that they had made a bad purchase, buyer’s remorse, then there is something called a Medicare Advantage Disenrollment Period that lasts from January 1 to February 14. During this period, a person can dis-enroll from their Medicare Advantage Plan and return to original Medicare.
Jim: Okay. Can they add the drug coverage to their new plan too?
Howard: Absolutely. They can also add a Part D drug plan; a stand-alone-plan if they don’t already have one.
Break: Thank you Howard; let’s take a quick break. Stay tuned! When we come back, we’ll discuss the steps you’ll need to take to make changes to your Medicare plan.
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Jim: Howard, how do you request to change plans and when does it become effective?
Howard: Well Jim, a person can change plans simply by joining a drug only plan which automatically dis-enrolls a person from their prior plan when the new coverage begins. You can also call Medicare at 1-800 Medicare or the actual plan to dis-enroll. The change itself is effective the first of the month following the change request. So, for example, if you made the request in January, it will be effective February 1and if you made the request between February 1 and February 14, the deadline for this change to become effective is March 1.
Jim: If someone is having difficulty deciding whether they should change their plan during this disenrollment period, who can they talk to for help?
Howard: Well again, the best thing that they should do is call the plan first or they can call Medicare at 1-800-Mecdiare. But by all means, they can call the Virginia Insurance Counseling and Assistance Program at 703-324-5851, TTY 711.
Jim: Okay now, Howard, regarding 2012 Medicare and You handbook, I see that a Medicare beneficiary can now take advantage of a new special enrollment period that allows a person to switch anytime during the year from the plan they choose during the current open season and enroll into a 5 star plan. What’s this all about and how many of these 5 star plans are available to Fairfax County residents?
Howard: Well Jim, in an attempt to reward plans that scored well on quality and performance, Medicare decided to allow a Medicare beneficiary who is not happy in their current plan to enroll in what’s called a 5 star plan which is new this year but they only get to switch once during the plan year. This new special enrollment period doesn’t start until Dec. 8; The day after annual open enrollment period ends.
Now the problem that we have is not many plans have a 5 star rating. There are only 13 such plans nationwide and unfortunately none of them are located in Virginia. So folks need to be careful since the Medicare and You handbook shows 3 different 5 star plans listed in the back of their book but they can’t go by those ratings, they have to look at the ratings on the Medicare website to determine which plans might be a 5 star plan. It is what it is.
Jim: We want to remind our listeners that if you want to change your Medicare Advantage Plan back to the original Medicare, you have from January 1 through February 14 and you have until February 14 to add a drug plan as well. Remember, it’s a sweetheart of a deal because the last day to make your changes is Valentine’s Day.
You can make changes to your plan by visiting www.medicare.gov. If you have any questions regarding your plan, call 1-800 Medicare. That’s 1-800-633-4227 or call the county’s local VICAP Program at 703-324-5851.