14 May 2012

25 FAQs for Medicare Beneficiaries, Part 3

Posted by Jody under: Alternative Medicine .

You are guaranteed this right if you meet the following conditions:

You enrolled in a Medicare managed care plan upon first becoming eligible for Medicare at age 65;
You disenroll from your Medicare managed care plan within 12 months of your original enrollment date in the managed care plan; and
You apply for the Medigap policy of your choice within 63 days of the date your managed care plan coverage ends.
17.) Are all managed care plans leaving the Medicare program?

No, but some areas of the country will lose all managed care options on January 1, 2012.

18.) Why are some managed care plans leaving the Medicare program?
Medicare managed care plans are private companies that make business decisions to contract or not contract with Medicare. Managed care plans voluntarily enter into 12-month contracts (January ? December) with HCFA to serve Medicare enrollees. Each year, managed care plans have the opportunity to choose whether or not to renew their contracts, and generally must notify HCFA by July 1 if they are not going to renew.

19) Can HCFA make Medicare managed care plans continue their contracts to provide services to Medicare beneficiaries?
No. While HCFA is responsible for ensuring that managed care plans meet their contractual obligations, we cannot require them to stay in the

Medicare program.

20) Some plans have increased their premiums and/or reduced their benefits. Why does HCFA allow plans to do this?
All Medicare managed care plans must offer the basic Medicare benefits. However, the law gives plans broad authority to offer supplemental benefits and to set premium and copayment levels.

HCFA reviews the costs of all plan benefits to ensure that additional benefits are included, if necessary, and that beneficiary premium and cost sharing amounts fall within upper limits permitted by law. As long as the premiums and cost sharing amounts remain under these limits, we have no authority to disapprove increases.

21.) Will members of managed care plans leaving Medicare be able to keep prescription drug coverage, or is new coverage being made available?
If a member currently has prescription drug coverage through a managed care plan that is leaving Medicare, this coverage will end December 31, 2011. Members have the option to enroll in other managed care plans available in their area which may cover prescription drugs. However, the Medigap policies that must be made available to most members of a withdrawing managed care plan (policies “A”, “B”, “C” and “F”) do not include prescription drug coverage.

Medigap policies that contain prescription drug coverage are available, but insurers may refuse to sell a policy based on health status, may impose waiting periods for pre-existing conditions, and may charge you more based on these conditions.

Remember, if you had previous Medigap drug coverage (plans “H”, “I”, or “J”), and this was your first time in a Medicare managed care plan, and you leave the Medicare managed care plan within 12 months, you can go back to this policy if your old insurer still sells it.

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