Thousands of Medicare Advantage plan members in California are receiving letters that their health plans are closing from carriers such as Anthem Blue Cross and Health Net. Some of the health insurance companies will be leaving some counties completely while others will be offering new Medicare Advantage (MA) plans to their members. Regardless of the reasons, the plan closure triggers a Special Enrollment Period for Medicare beneficiaries to select a new plan offered in their county.
Special Enrollment Period for Medicare Advantage Plan closures
The Center for Medicare and Medicaid Services doesn’t allow MA plans to automatically migrate their members to new plans. Members of MA plans that are closing or “non-renewing” have several options available to them during this Special Enrollment Period.
- The member can do nothing and return to Original Medicare. If the Medicare Advantage plan included the Part D Prescription Drug plan (MA-PD), they will have to enroll in a stand alone Part D to avoid any penalty unless they are covered by a credible prescription drug plan such as from a retirement plan.
- The Special Enrollment Period for non-renewing plans in 2014 allows the member to select a new Medicare Advantage by February 28, 2014. Between when the closing plan ending on December 31, 2013 and when a new MA is selected and activated, the member would be in Original Medicare.
- The member can enroll in a new Medicare Advantage plan being offered in the county during the Annual Enrollment Period or Open Enrollment October 15 to December 7 for an effective coverage date of January 1, 2014.
- A Medicare Advantage plan that is non-renewing also allows the member to return to Original Medicare and purchase a Medicare Supplement plan. The special circumstances of the MA deciding to close the plan gives the member a “guarantee issue” window to select a Medicare Supplement (also known as Medigap) with no underwriting. In other words, you can’t be denied for a pre-existing condition This special right to buy a Medicare Supplement plan will last for 63 days after your MA coverage ends.
If a Medicare beneficiary returns to Original Medicare, with or with a Medigap plan, they will need to enroll in a Part D Prescription Drug plan.
What if my plan stops participating in Medicare?
From the 2014 Medicare and You Handbook, Page 114
Medicare health and prescription drug plans can decide not to
participate in Medicare for the coming year. Plans that choose to leave
Medicare entirely or in certain areas are “non-renewing.” In these cases,
your coverage under the plan will end after December 31. The plan
will send you a letter about your options before Open Enrollment.
You can always choose another plan between October 15–December 7.
Your coverage will begin January 1. If your plan is non‑renewing for
the next year, you’ll also have a special right to join another Medicare
plan until February 28, 2014.
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