Medicare Open Enrollment Get Ready NOW

by Mary Jane Stern

In just a few weeks Medicare open enrollment season starts.  You can make changes between November 15 and December 31, the “marketing season” starts around October 1st.

Why Change?

What’s the biggest reason for change?  Rise in premiums for Advantage and Part D plans.

Another reason for change is you had selected an Advantage plan and found out, during the middle of the year, your hospital(s), your doctor(s) or diagnostic facilities are not preferred providers any longer.  This can be very costly to you.

Recently here in Florida, Martin Memorial Hospital and United Healthcare’s Medicare Advantage program contract discussions fell apart and approximately 1,600 plan members lost hospital access rights, in the middle of the year!  About 800 are affected in the immediate area.

The problem is the contract between the two ends on September 30th and Martin Memorial Hospital is now telling prospective patients that they are not a preferred provider and they will have to be a “self-paying” patient.  Members, of course, have a few other options but the driving distance can be quite trying.

The only way Martin Memorial will accept a patient is in an emergency and emergency only.  Now this makes it really difficult for members because they will have to wait until November 15th to elect a new Advantage plan or make the switch back to Original Medicare Parts A and B with a standalone Part D drug plan, and it won’t be effective until January 1, 2010.

Something I had never thought about before when selecting an Advantage plan was the contract dates between the health insurer and the preferred providers.  You would think contracts run from January 1 – December 31.  Not in this case.

My New Guideline

If you have been a victim of failed contract negotiations between your Advantage plan and your preferred provider, here’s my new guideline when selecting a plan during Medicare Open Enrollment.

Ask the representative of the Advantage plan when the contract expires between your preferred provider and the Advantage plan.  If it is in the middle of the year, you might rethink and check around for another plan so you don’t lose benefits as members did with United Healthcare’s Medicare Advantage Plan and Martin Memorial Hospital.

One great feature of Original Medicare, a single payer system, is you have freedom of choice.  You can pick your doctor, your hospital, your outpatient facility.  There are few, if any, restrictions.

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