Switching my Medicare Advantage Plan outside of "general open enrollment"?

[fffred]

I recently found that a large local medical group (at which I see at least 3 doctors) will no longer accept FloridaBlue Medicare Advantage. This surprise came after the end of the open enrollment period last December 7.

Tonight I saw an article at the "Fool.com" website indicating that there's a special enrollment period for those in Medicare Advantage Plans who either want to change the MA plan or go to straight Medicare (see https://www.fool.com/retirement/2020/03/01/attention-seniors-it-may-not-be-too-late-to-change.aspx).

Medicare seems to indicate this (at https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan  ...click the part about Medicare Advantage Open Enrollment) is true and the period extends from January 1 to March 31. There are some restrictions on this but if true I am tempted to go back to the regular Medicare plans (and I will have to re-educate myself on all of these, ~sigh~)

Can anyone confirm this rule? Thanks!

[somarco]

@fffred  you can disenroll from your MA plan and go to another MA or original Medicare.

If you opt for original Medicare there is no guarantee you will qualify (medically) for a supplement plan.

BEFORE disenrolling you should apply for a Medigap plan and make sure your application is accepted. If your application is denied you still have another MA plan as an option unless you have ESRD

[GailL1]

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@somarco wrote:

BEFORE disenrolling you should apply for a Medigap plan and make sure your application is accepted. If your application is denied you still have another MA plan as an option unless you have ESRD

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See, that's why you are the expert - I would have never thought of doing that -

but now I have it filed away in the ole brain; hopefully to never forget.

OFF-TOPIC - BTW, ya'll need any rain up there in North ATL?  We have some to spare. 

[somarco]

@GailL1 your brain is like a steel trap. Don't know how you keep all that information stored and still manage to make sense of it.

Got plenty of rain here but no flooding, power outage or downed trees.

Shameless plug follows . . .

I am collecting Kudo's for my retirement. Contributions gladly accepted.

[fffred]

@GailL1 

@somarco 

Thank you both for your insights on this tactic.

This is my second full year on Medicare and using a FloridaBlue Medicare Advantage plan. With my doctors' group "firing" this plan the plan's attraction is dimished. Thank you for the tips.

[somarco]

@fffred With my doctors' group "firing" this plan the plan's attraction is dimished. 

Firing goes both ways.

Provider can kick the carrier to the curb or vice versa.

Managed care agreements don't run on a calendar year. Even if your favorite doc is in network now doesn't mean they will still be by summer. Things can change on a whim although most of the provider square dance usually tracks their contract. At any point during the year either party can leave the dance.

Original Medicare is the ONLY way to be reasonably assured of unfettered access to health care without carrier interference.

[fffred]

@somarco 

Thank you for your comments. Very interesting. My BIL is involved in consulting/education for the business-end of medical practices [having moved from medicine itself] and he discussed a number of such issues as you describe (I follow his company on Twitter as well for general info).

After this situation with Medicare and the Advantage carrier, and the train wreck we encountered only 2 weeks ago with my wife's ACA insurance as provided by FloridaBlue, we have "had it". (well, not only with these two situations but a number of others.)

My wife has Canadian citizenship, as well as US, and we have idly considered moving to Canada now that we are retired. Having gotten reamed by the US health care system for both 2019 and 2020 the sting only makes it seem even less burdensome to move to Canada. Canada's public system is not perfect, by any means, as I have seen myself. But at least there is clarity and one knows where you stand.

(by the way, it was my doctors' group who elected to no longer accept the Advantage plan. I have been going there for 10 years and have continued to do so since retiring 2 years ago.)

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@somarco wrote:

@fffred With my doctors' group "firing" this plan the plan's attraction is dimished. 

Firing goes both ways.

Provider can kick the carrier to the curb or vice versa.

Managed care agreements don't run on a calendar year. Even if your favorite doc is in network now doesn't mean they will still be by summer. Things can change on a whim although most of the provider square dance usually tracks their contract. At any point during the year either party can leave the dance.

Original Medicare is the ONLY way to be reasonably assured of unfettered access to health care without carrier interference.

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[GailL1]

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@fffred wrote:

. . . . After this situation with Medicare and the Advantage carrier, and the train wreck we encountered only 2 weeks ago with my wife's ACA insurance as provided by FloridaBlue, we have "had it". (well, not only with these two situations but a number of others.)

My wife has Canadian citizenship, as well as US, and we have idly considered moving to Canada now that we are retired. Having gotten reamed by the US health care system for both 2019 and 2020 the sting only makes it seem even less burdensome to move to Canada. Canada's public system is not perfect, by any means, as I have seen myself. But at least there is clarity and one knows where you stand.

(by the way, it was my doctors' group who elected to no longer accept the Advantage plan. I have been going there for 10 years and have continued to do so since retiring 2 years ago.)

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Yes, you (and wife) seems to have had some health care coverage snaffus this year.  Gets tiring, I know - 

If you do decide to relocate to our northern neighboring country, make sure that you check the coverage offered by the province or territory for specific groups or services - some of these supplemental coverages are better than others.  The country of Canada offers no prescription drug coverage, nor are certain providers covered at the National level - some provinces make up for these lackings.  Also check the adequacy of the medical infrastructure in the area you are considering - again, some are better than others.

I will assume that the providers that you want to stay with here accept Traditional Medicare and if so, there will be room for you as an existing patient with them.  Some of the folks I know around here that are NEW to Medicare and want the traditional program are having a hard time finding a Medicare primary care physician that is accepting new patients.

Good Luck - BTW, did that ACA tax credit thing get worked out on your wife's plan?  Did the agent just forget to enroll her via the Marketplace?

[somarco]

@GailL1 Some of the folks I know around here that are NEW to Medicare and want the traditional program are having a hard time finding a Medicare primary care physician that is accepting new patients.

I keep hearing that from forums but have yet to see it personally (via clients). They are all over the state, top to bottom and side to side. 

Some are new residents from other states. Others just haven't seen a doc in years.

The only one that had a problem was calling and asking if they took (name withheld) Medicare plan. I sent him a list from the Medicare doc finder showing 100+ GP's in 15 miles of his home that take Medicare.

Had to tell him 3x to just ask if they take Medicare and don't mention the Medigap carrier. He finally did what I told him and the first one he called took him in. Only 2 miles from his home.

Concierge docs usually don't take Medicare. A few specialties like mental health, GYN and dermatology often don't take Medicare.

Quite a few don't take any MA plans or only participate in a handful of plans. Several won't participate in HMO plans.

Will work for Kudo's . . .

[somarco]

@fffred thank you for your comments and kind words.

No health care system is perfect, including Canada. They do a reasonably good job on primary care, not so much on major health issues.

There is a reason why folks in Canada come to the US for care but not the other way around (US to Canada).

https://torontosun.com/news/national/canadians-continue-to-leave-the-country-for-health-care-says-ne...

https://www.forbes.com/sites/sallypipes/2018/06/11/canadians-are-one-in-a-million-while-waiting-for-...

As mentioned earlier in this thread, original (US) Medicare is the only place those 65+ have unfettered access to care with essentially no wait time.

Your situation does not have to be life threatening to matter.

Last January my wife fell and broke her hip. She was admitted via the ER on Saturday and surgery to place screws in the bone the next day. Discharged 4 days later.

As it turns out a lady we know had a similar accident the year before. Her claim was workers comp. The carrier refused to authorize urgent or emergency care. Told her to take OTC pain medication.

She continued to walk on that leg a few more days and WC finally agreed to let her see a doctor. At that point the hip had started to necrotize but they did implant a hip.

She continued to have pain and a year later she was examined again. The doc said the artificial hip did not fuse because of necrosis and infection.

She had a 2nd implant.

Sub-par care does exist here if you have the wrong plan and/or wrong carrier.

My wife still has a few mobility issues but is 95% recovered.

You can't put a price on that.

[GailL1]

Yes, you can change your Medicare health plan and/or your Medicare Drug plan during Jan - March 31 

https://www.medicare.gov/blog/medicare-advantage-open-enrollment-2020 

But IF you want to go back to Traditional Medicare AND pick up a Medigap plan, that might be somewhat tricky - see the embedded link on Medigap within the above link.