ASK KIM


When Your Medicare Advantage Plan Is Discontinued

Kimberly Lankford

You'll get coverage under traditional Medicare, but it's better to consider all your options to find the best deal.



What happens if the insurance company that sold my Medicare Advantage plan to me discontinues that plan at the end of this year? Will I be able to qualify for another policy, or does it depend on my health?

You should have received a notice from your insurer in the past month if yours is one of about 100 Medicare Advantage plans that will be discontinued in 2009. When this happens, you'll be switched automatically to traditional Medicare, which will provide you with health-care coverage. That means you could get stuck with big out-of-pocket expenses for Medicare deductibles, co-payments and bills that aren't covered by the government program (such as for prescription drugs).

It may seem easy just to switch to another plan offered by your current insurer, but that might not be your best deal. In many cases, the insurer may be discontinuing its Medicare Advantage private fee-for-service plan that lets you use any participating doctor or hospital, but it may continue to offer a Medicare HMO or regional preferred-provider-organization plan in your area. Those other plans, however, may not cover all of the doctors and hospitals that your former plan did, may require prior authorization before using specialists and have a different cost-sharing structure than your current plan--leaving you with more expenses by the end of the year.

You could find a better deal through another Medicare Advantage plan, which provides all of your medical and prescription-drug coverage. Or you could stay in traditional Medicare and buy a Medigap plan plus a Medicare Part D prescription-drug policy to fill in the gaps.

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This is the perfect time to assess your options--open enrollment season for Medicare Advantage and Medicare prescription-drug coverage runs from November 15 to December 31, and during this time you can sign up for any plan regardless of your health.

This is not open-enrollment season for Medigap plans. You have the full range of Medigap choices available only within six months after you sign up for Medicare Part B. If you apply after that, Medigap insurers can generally deny you coverage or raise your rates because of your health. But if your Medicare Advantage or Medigap plan leaves the business, insurers must offer you Medigap plans A, B, C or F regardless of your health. Plan F is the most popular.

When considering all the options, compare the premiums as well as other out-of-pocket expenses for your typical medical costs and drugs. Also look at exclusions and coverage for major medical conditions.

It's easy to do that at the Medicare.gov Web site. You can find Medicare Advantage as well as Medigap policies available in your area using the Medicare Options Compare tool. Click on the "Estimated Annual Cost for People Like You" column, and you can find total out-of-pocket estimates for Medicare Advantage premiums and co-payments based on your general medical condition.

Another good resource for comparing Medicare Advantage plans is the Cost Share Report from HealthMetrix research, which ranks plans and shows out-of-pocket estimates for Medicare HMOs and PPOs that include drug coverage. You can search the results for plans in your area at MedicareNewsWatch.com.

And you can compare premiums and out-of-pocket costs for your drugs under the Part D policies in your area by using the Medicare Prescription Drug Plan Finder.

For more tips on comparing plans, visit the Medicare Rights Center Web site.

Even if your plan isn't leaving the business, compare your options because some of the largest Part D companies are increasing their premiums substantially in 2009. See Time to Revisit Your Medicare Part D Prescription Drug Plan.

Got a question? Ask Kim at askkim@kiplinger.com.




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