AmeriHealth just sent me a letter that my Medicare Advantage Plan will no longer be available. What do I do now?
This is not uncommon. For many folks in the Philadelphia and Southern New Jersey area this issue has become all too familiar. You did your research, you picked a plan you felt worked for your situation, the plan may or may not have satisfied your needs and then one day in late September you get this wonderful letter from the insurance company that the plan you currently have is no longer going to be available.
For many the first thought is anger. Why is this happening? What am I supposed to do now? I have health issues, will a new company even take me? Do I have any special rights? When do I have to make changes? Will this happen again?
My name is Gregory Gudis of BGA Insurance Group. I am a licensed insurance agent and a Chartered Advisor for Senior Living®. I am going to take a look at each of these questions individually. Hopefully after reading my answers to these questions you will be fully prepared the next time this happens to you.
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Why is this happening?
Well typically like most things in this world it all comes down to money. If the insurance company is losing money they will take the steps necessary to make sure that stops. One of those steps is to raise premiums or raise copays; another may be to terminate the plan costing them the most. Some companies will still offer plans and some will totally pull the plug. For 2017 in South Jersey we are seeing Amerihealth pull the plug on their Medicare Advantage plans and Aetna is ending its Value plan but will have a new plan available. Without going into a 20 page explanation on how companies figure out pricing and the government subsidy they receive versus copays and how large or small a network they offer, let’s just keep it simple and say that if a plan does not renew then that plan must have been losing too much money to stay afloat and it was easier to just go away.
If you ever receive one of these letters it will be a very standard letter that adheres to the Centers for Medicare and Medicaid Services (CMS) guidelines. There will be an explanation of your plan ending; it will inform you if you will be consolidated into another plan offered by the company (in which you can do nothing and stay with that new plan) or if you will be returned to original Medicare effective January 1st with the need to make a decision prior to that if you want another Medicare Advantage plan.
The letter will also explain your special right to buy a Medigap Plan with no health underwriting for plans A, C, F, K or L (not all companies offer all of these options). There will also be a list of available Medicare Advantage and Part D plans available in your area.
What am I supposed to do now?
Contact a BGA Insurance Agent immediately! Ok, actually this part is up to you. Here is what the average consumer does:
First, they read the letter and follow it with some very choice words for the company, typically rather negative in tone; some may even call the insurance company and question the letter, yell at the person on the other end of the phone, or even tear up the letter (please don’t do this).
Second, once everything calms down many will begin to research what to do. This can take countless hours to look into something you really do not want to be bothered with but realize you have to because this is your health care after all.
Third, some folks go to seminars and/or set up meetings with insurance agents to hear about their options. Lastly, folks make their choice of either another Medicare Advantage plan with hopes this does not happen again, choose a Medigap Plan and a Part D prescription drug plan (PDP), or do nothing (possibly the worst choice).
I am here to tell you what I would do if I was in your situation. First and foremost do not destroy that letter! This is basically your golden ticket to a new insurance plan. Also, I don’t recommend calling the insurance company unless they are offering another plan and you want information on that plan.
Second, don’t do all the research on your own. This could take you several hours or days and you may still not totally understand the new plans or your rights as a Medicare beneficiary. Contact a BGA Insurance Agent, go to a seminar, set up an individual meeting with an agent, just don’t go it alone. If someone sued you your first contact would probably be an attorney because he/she will know best what to do. That is their job, that is what they are trained to do. The same goes here.
BGA Insurance Agents specializing in health insurance for Seniors are trained to do just that; help you with these plans. Lastly, before making a final choice make sure you weigh the option between Medicare Advantage and Medigap Plans. The agent you meet with can give you a good comparison. Remember, if you are someone who is not completely healthy your letter gives you the right to get a Medigap Plan with no health questions.
I have a health issue, will the new company even take me?
Plan and simple, yes they will. Medicare Advantage plans do not ask health questions other than if you have End Stage Renal Disease and the Medigap Plans mentioned above will also take you as Guaranteed Issue. That means they will not ask any health questions as long as you choose Plans A, B, C, F, K or L. If you were interested in another Medigap plan like say G or N you would have to answer some health questions that could preclude you from getting the coverage.
When do I have to make changes?
Your plan has a contract with Medicare until the end of the year, therefore your coverage will last until December 31st. If you do nothing then as of January 1st you will be on Original Medicare (Medicare Parts A and B only) leaving you with a great deal of potential out of pocket costs.
Beginning October 15 is the Medicare Annual Election Period when with, or without, a letter you can start making changes. You can make any change you like from the period of October 15th through December 7th to take effect January 1st.
— BGA Insurance Group (@BGA_Insurance) August 4, 2016
You will also have a Special Enrollment Period that will actually give you more time to make changes for January 1st and even allow you to make a choice after you have already lost the coverage, however I do not suggest waiting that long. You are better off getting this done as quickly as possible rather than wait.
BGA Insurance Group has over 30 agents ready to help you look into all of the options in your area.
Will this happen again?
I hate to sound like a Magic 8 Ball but “Signs point to yes.” If you purchase another Medicare Advantage Plan you may see this happen again in the future. Unfortunately, until something changes with how our healthcare system works this could be an ongoing thing. Don’t worry too much about this when picking a plan.
In fact, don’t try picking a plan because you think they may stay in the market longer than another. No one truly knows including the plan itself. Pick a plan based on what is best for you and work with a BGA Insurance Agent who brokers many companies so that if this does happen again he/she will be able to help you make your next choices.
If you purchase a Medigap Plan then this most likely will not happen to you again. Medigap Plans do not typically leave a state or area the way a Medicare Advantage Plan does. Your agent can explain further but with a Medigap Plan you may see more stability on an annual basis because the benefits do not change (but the premium can and normally will rise a little each year).
If there is only one thing you take away from this discussion; when you receive a letter from your Medicare Advantage Plan telling you they are not renewing your plan, contact an agent quickly and discuss your rights, entitlements and options.
Look for an agent who does not work directly for any specific insurance company, look for a broker who can discuss several companies with you and show you all of your options.
That is what BGA Insurance Group does for their clients and we make sure they are in the best position possible with their new plan when the first of the year hits. Hopefully I have answered these important questions but if you need further information please contact me at 855-494-0097 ext 302 or via email: firstname.lastname@example.org
Gregory J Gudis
Gregory is one of the founders of BGA Insurance Group and while remaining dedicated to his clients he also handles many of the day to day business activities of the company. Gregory is a Graduate of Rowan University and obtained his Master’s Degree from Rutgers.
His primary reason for creating BGA Insurance Group was to help Seniors navigate the labyrinth known as retirement. To further his knowledge base and better assist his clients he obtained the designation of Chartered Advisor for Senior Living®. The CASL® designation focuses on the issues facing clients who are planning for or are living in retirement. Gregory resides in Haddonfield, NJ with his wife Tara, son Bryce and his 2 dogs Mason and Juno.