DH has enrolled in a medical advantage plan for a few years. He picked his plan through ehealthinsurance. He has not seen a doctor for many years.
About a month ago, he decided to switch and again went through ehealthinsurnace to pick a supplemental plan and it was covered under Aetna. He never heard from Aetna but received a call/email from ehealthinsurance to contact them (as if there was an issue), he did, but was told that it was just normal call and there was no issue. Separately, he also picked a prescription plan.
From what I read here, it seems that it may not be a straight forward transition from MA to Supplemental plan, hence I asked him to confirm the status of the new plan. He was confident as he already talked to ehealthinsurance, felt that in the worse case he could still keep his existing MA. However, today he received notification that he will not have the MA for next year, apparently because he purchased the prescription plan (i.e. he has another coverage). But he has not received any correspondence from Aetna therefore he thinks that Aetna application may not gone through. He planned to call ehealthinsurnace to find out tomorrow.
But I am afraid that they just give him any generic answer. I am thinking to get him just to buy directly from United Health with AARP, but is it even possible now? I thought the deadline was Friday. Can he ask to stay with his existing MA? Will it be too late too? If it is too late, what other choice does he have besides buying through ACA?
Can he sign into medicare.gov to see what that shows about coverage status? It seems like step one is to clarify what he does or doesn’t have.
There is no open enrollment for Medicare supplements (medigap), but there is medical underwriting and exclusionary periods for pre-existing conditions. So I think he can apply any time he wants, year round… but no guarantee of acceptance.
Since he did sign with Aetna, he should also contact them. There should be a way to verify status of enrollment.
@calmom thank you. I didn’t know we can log onto medicare.gov (I have to check for myself too) and there is no open enrollment for medigap, therefore what was the deadline on Dec 7 for? Did you mean that he can switch any time ? I thought the open enrollment period ends Dec 7.
I swear we got a thing this year that also said one could switch Medicare plans, I believe within 90 days of the close of the open enrollment period. This is new for 2019.
At a recent presentation by Kaiser Foundation on their newly available advantage plan (in our area) the topic of a ‘five star rated plan’ was introduced. I know almost nothing about this other than it appears that if you are trying to switch INTO a 5 star rated MA plan you have open enrollment until November 30th. Not sure if this helps the OP and frankly, this exception is just…Weird…
@dietz199 The 5-star rule also applies to drug plans — so people can always switch into either a Part C (MA) and/or Part D (drugs) at any time of the year. I think it’s a rule to incentivize plans to meet the criteria for the 5 star rating-- and it also provides a safety net in the event of poor service from an MA or drug plan. So if you find out in February that there are significant problems with the plan you signed up for – you have an option.
@annamom – the open enrollment that ended December 7th is for initial enrollment and/or switching drug plans is for the Part C (MA) and Part D (drug) plans. And the extended enrollment period for 5 star plans is also for Part C/D only.
Medigap (supplement) is a different animal. Again – no specific limits on time of enrollment… but the company doesn’t have to accept you either. (Unless enrolling within the initial designated period after starting Medicare for the first time)
A closed-end open enrollment is needed in combination with any guaranteed-issue plan to prevent people from simply signing up for the plan with the lowest premium and then swapping to something else if medical needs arise.
A good example is me – I don’t take any prescription drugs, so I signed up for the super cheap plan at $13/month. This plan has 2 stars from Medicare. If I get diagnosed with a chronic condition requiring expensive meds in, say, March – I might find that my 2 star plan has lousy customer service and doesn’t even include my expensive brand name drug in its formulary. If I could just switch any time… then I might go the route of switching in March, and then switching back in August if I didn’t need the pricey meds any more I could switch plans.
There are no 5-star plans in my area – so I’m out of luck in any case – but if there was a 5 star drug plan, it probably would cost a lot more than $13/month. (The 4 star plans are $80 with a $415 deductible, $120 with no deductible )
Something needs to be sacrificed to get to a low premium. So if and when I do need to use my RX drug card, I might find that the plan formulary is restricted and its customer service is terrible.
@calmom thank you. what is open enrollment? I thought people enroll when they turn 65, hence, I am assuming there is no universal period to enroll.
In the case for DH, he called today and spoke with at least 3 agents from ehealthinsurance and 3 from Aetna, there was the usual run around, one agent from ehealth told him, they were waiting for Aetna, and Aetna did not ask them for anything, and there was another one told him to call Aetna directly. One told him that they had contacted him and he was expected to do an underwriting interview (he explained that he did call back but was told that nothing to follow up). Now he submitted a written answer for his current health condition (He has no medical issue) and will have to wait. It seems that you are correct that he can switch any time. However, the problem is that he received a letter from his MA provider telling him they are going to cancel him (as he has successfully enrolled in a Drug plan), but he has 30 days to call them to let them know he stays with the MA plan. Hence, he needs Aetna to approve him before the end the 30 days.
“Open enrollment” is the period each year from mid-October to early December when all Medicare enrollees can switch freely to a different Medicare Advantage (Part C) and/or Drug (Part D) plan. During that period there is guaranteed acceptance. You might do this to save on premiums, or because you want to have a different medical network.
Example - in my state, in 2018 the cheapest Part D drug plan was around $22 a month. But this year the prices have gone down – my $13 company is new to the California market – and some other plans that had premiums of $22 last year are now $15. So it makes sense to shop around each year rather than stay locked into a play with, say, a $35 monthly premium because that was what seemed like the best deal when the person first signed up 3 years ago.
@calmom thank you. Got it. That means someone can switch Medical Advantage during the open enrollment period, but can switch anytime during the year for medigap plans…
Does anyone know whether it is possible to apply to more than one medigap plans at the same time?
Now that I think about it, I think one of the Aetna agents told us that Aetna does not have Plan N in the county (his words were we do not have the plan DH applied for, therefore DH should look for a different plan), according to the agent he told ehealthinsurance, but none of the ehealthinsurance agent brought it up when we talked to them and we were even told that he has to do an underwriting interview before Aetna could make the decision. I checked Aetna website and did not find Plan N for the county I am going to get him to call Aetna and ehealthinsurance again tomorrow, but given all the different answers, I am not sure how much we can trust the words from ehealthinsurance, hence I am thinking to get him to apply directly to AARP United Health as I am sure it offered Plan N. He needs to know by Dec 22 that he can enroll in a medigap plan.
@lookingforward thank you. It helps. I have been worried that if his MA plan cancels him, he will have to make sure he is enrolled back to Part A and Part B. But it seems that he will be automatically enrolled “Leaving the Medicare Advantage plan automatically returns you to Original Medicare, Part A and Part B.”, but I am going to get him to call medicare to confirm.
However, when I went down to the page and there is an option to find the medicare plan in his area, when I clicked on it, it brought him to the same ehealthinsurance page (same URL) which showed Aetna has Plan N in the area, but it wasn’t what Aetna told us. We will have to call them, but as we have been different answers by different agents, I just do not have the confidence with their answers.
@annamom there are brokers in every state that can offer you assistance in comparing and choosing Medicare Plans. We have a lot of friends who have used them…and gotten great plans for them, plus they got their questions answered.
You seem to be gettin ALL of your Medicare info on College Confidential, and certainly there are some very knowledgeable people on this site.
Does anyone know what to do when you need an expensive drug? We’re looking at an Advantage plan. When I type in the med’s name, a message just comes up that it’s not covered by Medicare Part D. One dose last month for DH was $16,000. He needs only in case of surgery or bad accident, but then it is mandatory. What do we do??
Social Security actually called this morning when they said they would, unlike last week with my son when he got stressed out and ended up in the hospital.
The very nice, competent guy signed DH up quickly for Parts A & B. He scared me for a second when he said, “Oops, you were supposed to sign up by last July to avoid the penalty…” What?!? Before I could say anything, he caught his mistake - he thought DH had already turned 65, but he doesn’t until March, 2019.
I told the SS employee that he was a breath of fresh air after my last few disastrous encounters with the agency. He said to call him if we have any more issues! I’m not sure what he could do to help, but I was impressed by him.
@thumper1 reg post #13 I see nothing wrong in learning from CC and I wrote many times that I learned a lot regarding health care plans on this site. There are many knowledgeable and helpful people on this site.
This is not good.