Do you have a client who is unhappy with their new private health plan? Inform them they can still switch health coverage during the Medicare Advantage Disenrollment Period (MADP).
As you know, every year from October 15 to December 7, seniors are given the option to review their Medicare and Part D coverage and switch to other plans during the Annual Enrollment Period (AEP). Changing plans can be a scary move for those over 65 as they fear going from the known to the unknown on a fixed income. What happens if they make the move to try out a private health plan for the first time, or switch private health plans, and then feel like their new coverage is not the right fit?
Luckily for them, they’re not stuck with their new coverage. Almost immediately after AEP, seniors in private health plans can participate in the MADP.
As an agent, it is important for you to understand the MADP and how it works. We’ve put together this informative guide to help better prepare you to assist your clients who might have buyer’s remorse.
A Brief Overview
The MADP occurs between January 1 and February 14 every year. Unlike AEP, which invites all seniors to add, drop, or switch health plans, the MADP is only open to seniors with private health plans.
During this Special Election Period (SEP), those enrolled in stand-alone Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), and Medicare Private Fee-For-Service (PFFS) plans can choose to move from their current policies to Original Medicare. Therefore, those who may not be satisfied with the private health plan they selected during AEP have another option besides being left in dismay.
All changes made during the 45-day MADP go into effect the first day of the following month. For example, if your clients disenroll from a private health plan in January or February, their new coverage will start February 1 or March 1, respectively. Once the MADP ends, beneficiaries will have to wait until the next fall AEP to change their coverage unless they qualify for another type of SEP.
What Your Clients Can Do During the MADP
Beneficiaries are fairly limited as to when they can modify their health coverage during the calendar year. The MADP is not another open enrollment period where any senior can change, drop, or add health coverage as they wish. There are restrictions.
If your client has a stand-alone MA plan or an MAPD plan, they can request disenrollment and switch to Original Medicare. Once the request is received, they will receive an SEP to enroll in a stand-alone Prescription Drug Plan (PDP) if they desire.
Beneficiaries currently enrolled in a stand-alone MA plan and stand-alone PDP may switch to Original Medicare; however, they may not make any changes to their PDP. Likewise, those enrolled in a Medicare PFFS plan may switch to Original Medicare, but must also keep their current PDP.
What Your Clients Cannot Do During the MADP
Seniors with a stand-alone PDP who are not enrolled in an MA plan cannot enroll in an MA plan and cannot make changes to their current PDP coverage. Those enrolled in Original Medicare with or without a PDP cannot switch to a MA, MAPD, or PFFS plan. Additionally, they cannot join, switch, or drop a Medical Savings Account (MSA) plan.
Moreover, beneficiaries enrolled in a private health plan cannot switch to a different private health plan during the MADP. For instance, those with an MA plan cannot switch to a different MA plan or an MAPD. Their only options are to switch to Original Medicare and, if they qualify for a PDP SEP, add a stand-alone PDP.
If your client is able and wishes to enroll in a stand-alone PDP, they must do so before February 14, the end of their SEP. It is important to note that the effective date for their PDP enrollment cannot precede the date of their MA disenrollment.
Med Supps During the MADP
A beneficiary who disenrolls from their private health plan may be able to enroll in a Medicare Supplement (Med Supp) plan, also known as a Medigap plan, after returning to Original Medicare. However, it is important to stress to your clients that this will not get them a guaranteed issue Med Supp enrollment. Beneficiaries must pass underwriting and be approved.
Federal law does not give beneficiaries the right to purchase a Med Supp plan; however, laws in their state may permit them to enroll in such a plan. Seniors can check with their State Health Insurance Assistance Program (SHIP) to find out if and when they are eligible to enroll in a Med Supp plan in their respective state.
Agents should not write beneficiaries into a PDP until they are sure the beneficiary is both eligible and approved for their requested Med Supp plan. Enrolling a beneficiary in a PDP will automatically remove the beneficiary from their current MA or MAPD plan. This can cause them to go without coverage until their next SEP or the next AEP.
Something to Think About
Going into this New Year, reach out to your clients to make sure they understand their plans, and that they are happy with them. Let them know you are available if they have any questions or need further assistance. By doing so, you will provide your clients with a feeling of security, and as a result, they will be far more likely to refer their family and friends to you.
Remember, if you are not contacting your clients, another agent may seize the opportunity to gain their trust. A client who has questions or is confused with how the plan is far more susceptible to let another agent write them into a Med Supp and a PDP. Protect your business; don’t let the hard work you put into AEP go to waste.
If you have clients who are dissatisfied with their current coverage, take the time to help them decide if participating in the MADP is a good choice for them. Sit with them, assist them in comparing their coverage options, make sure they understand their plans, and review the consequences of switching to Original Medicare and enrolling in a Med Supp. And if they’re going to make changes, be sure to warn your clients about possible gaps in their prescription drug coverage as this can lead to high out-of-pocket costs for them.
The MADP is a 45-day window of opportunity that offers an outlet for unhappy shoppers. By comprehending its basic nature, you can make sure that you’re equipped to assist your clients in their time of need.