14 May 2012

25 FAQs for Medicare Beneficiaries, Part 2

Posted by Jody under: Alternative Medicine .

People in these two groups are allowed an initial 12-month period in which to try out Medicare managed care. This period runs from the date of their “first time” enrollment in the Medicare managed care plan. Depending on the date they initially enrolled in a managed care plan, these beneficiaries may need to act quickly in order to take advantage of their extra rights.

For instance, beneficiaries whose enrollment in the managed care plan began on August 1, 1999 would need to disenroll from their plan by July 31, 2011 in order to get these extra choices.

If you think you may be entitled to one of these 12-month periods, talk to your State Health Insurance Assistance Program. It is important that you not act on the assumption that you are entitled to these extra protections without getting expert help.

BUT if you are in this 12-month period, you must actively disenroll before your 12 month period ends and before you are automatically disenrolled on December 31, 2000 in order to exercise the broader choices that are available to you.

Remember, however, if you are in one of these two groups and you stay in your plan until December 31, 2000, you will still have the same rights as others who will be disenrolled at that time.

14.) What if I dropped a Medigap policy before I joined this Medicare managed care plan? Can I return to my old Medigap policy?
Maybe. If you are age 65 and over and you dropped your Medigap policy to join a Medicare managed care plan, you may be able to buy the same type of Medigap policy you had before IF:

A. The Medigap policy you dropped is still being sold by the same insurance company;
B. This is the first time you have ever been enrolled in any kind of Medicare managed care plan;
C. You leave (disenroll from) this managed care plan within 12 months of joining the plan; and
D. You apply for your previous policy no later than 63 days after coverage from your managed care plan terminates.
Before you disenroll from your managed care plan you should make sure the policy is still available from the original insurer. If the previous policy is no longer available, you are still guaranteed the right to buy a Medigap policy designated “A”, “B”, “C”, or “F” that is offered by insurers in your State. You can use your right to return to your old Medigap policy any time during the first 12 months that you are enrolled in the managed care plan.

NOTE: This right also applies if you are under age 65 to the extent policies are made available in your State to beneficiaries under 65.

15.) What if I joined this managed care plan when I first turned 65 and I have been in it less than 6 months? Do I still have a Medigap open enrollment period?

During the first 6-months an individual is both 65 years of age or older and enrolled in Medicare Part B, the individual has what is called a

Medigap open enrollment period.

During this period, an insurer cannot:
(1) refuse to sell you any of the 10 standardized Medigap policies that the insurer sells in the State, including the three called, “H,” “I,” and “J,” which contain outpatient prescription drug coverage;
(2) delay the issuance or effectiveness of the policy; or
(3) discriminate in the pricing of such policy because of your health status, claims experience, receipt of health care, or medical condition.
If you became entitled to Medicare Part A at age 65 within the last 6 months, you may still have some time left in your Medigap open enrollment period which you could use.

You did not lose it because you decided to enroll in a Medicare managed care plan when you first became entitled to Medicare Part B at age 65 or older.

16.) Do I get any special protections because I never got to use my 6-month Medigap open enrollment period because I chose this HMO instead?
Even if your Medigap open enrollment period has passed or will expire very soon, you may be guaranteed the right to buy any Medigap policy (Plans “A” through “J”). These include the three plans that cover outpatient prescription drugs.

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