Insurance companies that offer Medicare Advantage plans engage in a familiar ritual every fall. Beginning in early October, they introduce their plans for the coming year. This is also the time, if plans are not being renewed for the following year, that notices are sent to those plan members informing them of their plans renewal status and detailing the options that they have available.

If your Medicare Advantage plan is not renewing for 2011, there are certain things that you need to be aware of and several steps that you need to take to make sure that you are properly protected in the coming year.

Understanding the realities of your plans renewal status and knowing what steps to take can give you the piece of mind required to make an informed decision for the following year.

Why do insurance companies choose not to renew their plans?

Often, when Advantage plan members receive a notice from their insurance company informing them that their Medicare Advantage plan will not be renewed, the first response is anger. Most of us like some degree of certainty. Having the rug pulled out from under our feet, especially when it comes to our insurance and health care, is unsettling.

If we understand the reality of how an Advantage plan works, we should be able to anticipate possible changes. When an insurance company contracts with CMS (Centers for Medicare and Medicaid), they agree to an annual contract in a defined County or service area. By design, you should be aware that things can change from year to year. Understanding this can alleviate any anger.

Beginning in January 2011, companies that offer PFFS (private fee-for-service) Advantage plans, will be required to allow those members access to a provider network should they decide to utilize it. A PFFS plan is not a network based plan, but rather members are able to visit any provider that accepts Medicare assignment. The provider must agree to accept the plans payment terms and conditions, as well as having the right to accept the plan on a visit-by-visit basis.

If a company decides not to renew your Medicare Advantage plan for 2011, this could be due to not having a credible network in place for your County or service area. If an insurance company only has one plan available, and it is a PFFS plan, it may be an easier and a more cost efficient solution for them to merely pull out of the market.

What do I need to know?

First, you need to be aware that the insurance company has a contractual obligation to honor their commitment to you. Your plan is still a valid plan for you to use for the remainder of the calendar year. Claims will still be paid and customer service will still assist you with any issues that may arise.

In addition, you now have a guaranteed enrollment period to apply for a Medigap insurance policy. If you decide to apply for a Medigap policy, which is also known as a Medicare supplement, the company cannot refuse to sell you any plan that they offer. Health conditions will not prevent you from purchasing a Medicare supplement during a guaranteed enrollment period.

What do I need to do?

If your Medicare Advantage plan is not renewing for 2011, you need to assess you options. It is comforting to know that you have several choices.

  • Return to traditional Medicare and purchase Part D drug coverage.
  • Enroll in another Advantage plan.
  • Purchase a Medicare supplement and Part D drug coverage.

If your Medicare Advantage plan is not renewing for 2011, start exploring you options early. Your current Advantage plan will end at midnight December 31st. You are not required to stay with the same company should they have an alternative plan available. It is in you best interests to take this time to look at all available options. Armed with knowledge, you can choose the right coverage and be protected for the following year.


Source by David Forbes