[US] Medicare Advantage Open Enrollment ends March 31

Daniel

daniel@psychlinks.com
Administrator

Don’t wait: Medicare Advantage Open Enrollment ends March 31

Mar 01, 2021
Medicare.gov

Did you know that if you’re unhappy with your Medicare Advantage Plan (Medicare Part C), you have options? Each year, there’s a Medicare Advantage Open Enrollment Period from January 1 – March 31. During this time, if you’re in a Medicare Advantage Plan and want to change your health plan, you can do one of these:
If you switch Medicare Advantage Plans or go back to Original Medicare with or without a Medicare drug plan, your new coverage will start the first day of the month after your new plan gets your request for coverage. Keep in mind, if you go back to Original Medicare now, you may not be able to buy a Medicare Supplement Insurance (Medigap) policy.

The Medicare Plan Finder can help you find, compare, and enroll in a new Medicare Advantage Plan or a Medicare drug plan in your area. You can also call 1-800-MEDICARE (1-800-633-4227) for help. TTY users can call 1-877-486-2048.

The Medicare Advantage Open Enrollment Period isn’t for people who already have Original Medicare.

It’s important to understand and be confident in your Medicare coverage choices. If you have a Medicare Advantage Plan and want to change your plan, check out your options today. Remember, this Medicare Advantage Plan Open Enrollment Period ends March 31.
 

Daniel

daniel@psychlinks.com
Administrator
This is older information, but it correlates with my sister-in-law's positive experiences with Aetna after many hospitalizations:


I have Aetna now as well, after having a no-name insurance company last year that denied as much as it could -- even routine bloodwork. In my sister-in-law's experience, Aetna never denied anything.

Regardless of the insurance company, though, I have learned the important thing is to get a PPO (instead of a HMO) so you have infinite flexibility in getting a therapist compared to a HMO. Also, with Medicare Advantage plans, it is possible your therapist or doctor may not accept your Medicare Advantage plan -- even if they are contracted with the same insurance company. So having a PPO that pays for out-of-network claims prevents such painful surprises.

The downside with a PPO is that the co-payments may be somewhat higher. But a PPO is worth the flexibility and peace of mind for me. In other words, you get what you pay for.
 
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Daniel

daniel@psychlinks.com
Administrator
I am going with UnitedHealthcare for next year instead of Aetna. Aetna is taking forever to process one of my PPO claims regarding over $400 of therapy sessions. It has been well over four months with no sign of being even initially processed yet -- after multiple methods of me contacting customer service, including fax, e-mail, and calling. According to Aetna, claims are usually processed within two months..
 
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Daniel

daniel@psychlinks.com
Administrator
Still glad I left Aetna. After 7.5 months and numerous reminders from me, they have finally processed my largest out-of-network claim of $450 (reimbursement for five therapy sessions). It seems I was finally able to get the attention of a supervisor, which was almost impossible earlier.
 
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Daniel

daniel@psychlinks.com
Administrator
If you get Medicare along with SSDI, you can be any age to get a Medicare Advantage plan. I started at age 43 or so after being frustrated with the limits and expense of Original Medicare.

I am still definitely saving a lot of money. For one thing, most therapists will not take any Medicare-related insurance, so a Medicare Advantage PPO plan is the way to go (allowing out-of-network reimbursement).

Medicare Advantage plans also usually pay for preventive dental care, and they have always paid the full amount for bloodwork without nitpicking about the diagnosis code (unlike Original Medicare).

Now Aetna is doing a better job than UnitedHealthcare. UnitedHealthcare is requiring me to file an appeal, even though they admit to the mistake of denying my claim completely. For another claim, they only paid two thirds of their usual amount, so that is another appeal to submit.

I recently submitted dental claims to Aetna from last year, and I was paid the full amount within a few weeks. So I will probably switch back to Aetna or try another Medicare Advantage insurance company like Humana.
 

Daniel

daniel@psychlinks.com
Administrator
Even with Medicare Advantage plans you still pay monthly Medicare Part B premiums, unless you qualify for Medicaid as well.


Medicare Part B premiums will decrease in 2023, marking the first time this cost has been lowered in more than a decade.

The Centers for Medicare & Medicaid Services (CMS) announced that Medicare Part B premiums would be lowered by three percent, or $5.20, going from $170.10 a month to $164.90.
 

Daniel

daniel@psychlinks.com
Administrator

Medicare open enrollment starts each year on October 15 and ends December 7. You can make changes that will go into effect the following year...

If you are already in an MA [Medicare Advantage] plan, you’ll have some extra time to decide what to do. The special open enrollment period runs from January 1 through March 31. During this window you can switch from one MA plan to another or to original Medicare...

Financial assistance if you can’t afford Medicare

If you are having trouble affording your Medicare premiums, copays and other out-of-pocket costs, the federal government has four Medicare Savings Programs that provide help for people with limited incomes. There is also a program called Extra Help that assists beneficiaries with their out-of-pocket costs for prescription drugs. Even if you haven’t qualified for these programs before, the open enrollment period is a good time to check to see if your financial circumstances now allow you to qualify.

The Inflation Reduction Act also may soon come into play. Beginning in 2024, Medicare beneficiaries with annual incomes of up to 150 percent of the federal poverty limit ($20,385 for an individual in 2022) who also meet the program’s resources limit can qualify for full benefits under the Extra Help program. The income threshold for full benefits currently is 135 percent of the federal poverty guidelines ($18,347 for an individual in 2022).

How to get help picking a Medicare plan

Beneficiaries can compare plans and change their enrollment by going to www.medicare.gov. During the open enrollment period, there is also live chat assistance on the website.

In addition, Medicare has a 24-hour, seven-day-a-week hotline where representatives can answer your open enrollment questions. That toll-free number is 800-633-4227. Also, every state has a State Health Insurance Assistance Program (SHIP) with counselors who can help answer your questions.
 

Daniel

daniel@psychlinks.com
Administrator
In my area, Humana has a PPO Medicare Advantage plan with $0 copay for psychotherapy, including for out-of-network providers.

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