As we all know the new Healthcare Reform that the federal government passed just recently is going to cause many changes to how we all access health insurance. Soon the private insurance companies that offer the Medicare Advantage (or MA/MAPD) and Medicare Part D plans will have to make some quick business changes. Starting in January 2011 there will be complete changes to the Annual Enrollment Period (AEP) and Open Enrollment Period (OEP) for the Medicare programs.
Currently the Annual Enrollment Period is from November 15th until December 31st of every year. It is a time frame in which someone can enroll into or disenroll from a Medicare Advantage or Medicare Part D plan. Its is a free period where your enrollment will not be denied unless you don’t live in a plans service area or if you don’t meet the eligibility requirements (having Medicare A&B, etc.). You can enroll for the first time into a plan, you can disenroll from a plan if you dislike it or you can change within your own company or to a completely different company if you already have a plan. The Open Enrollment Period is between January 1st and March 31st of every year. This is more centered around the Medicare Advantage plans. During this time you can make “like to like” plan changes. “Like to like” revolves completely around drug coverage. The OEP allows someone to enroll into or disenroll from a Medicare Advantage program. If you currently have a Medicare Part D drug coverage plan then you can leave that plan during the OEP time and go to a Medicare Advantage Prescription Drug plan (MAPD) but you cannot go to an MA only plan, which is a Medicare Advantage plan that does not cover drugs. If you do not have a Medicare Part D plan you will be allowed to enroll in a Medicare Advantage only plan but will not be allow to enroll into an MAPD plan. Basically you cannot gain or drop drug coverage during this time frame. You can also disenroll from your Medicare Advantage plan under the same guidelines, cannot gain or lose drug coverage, and go back to traditional Medicare A&B. These two enrollment periods are the only times in which someone can make any changes to their current coverage without having to fall under a special circumstance.
In the HCR Bill there is a section called Simplification of Annual Beneficiary Election Periods, this is the section that will require the Medicare enrollment periods to be changed. The 2010 AEP time will still be November 15th until December 31st, however, the OEP starting on January 1st 2011 will be completely different. The new OEP will be a 45 day period, starting 1/1/2011, where people who have a Medicare Advantage or Medicare Advantage Prescription Drug plan will be able to disenroll from their plan and go with a stand alone Medicare Part D plan and traditional Medicare A&B. They will be allowed to pick up a Medicare Supplement plan if that is what they choose to do. The “Like to like” rule where you can’t gain or lose drug coverage still applies. So if you have a MA only plan without drugs you will be able to drop it and go with traditional Medicare and a Medicare Supplement if you choose but cannot gain a drug plan. Changing from one Medicare Advantage to another or changing from traditional Medicare A&B to a Medicare Advantage will not be allowed during this time frame any longer. This may cause a fairly large hit to the insurance companies in their sales because many people in the past have enrolled into Medicare Advantage plans during this time frame. They will still get the possible sales for the Medicare Part D plans but they do not bring in the funds from the government like a Medicare Advantage plan enrollment does.
The new AEP time frame starting in 2011 is going to be from October 15th until December 1st. The same guidelines will apply, the only change is the time frame. This will actually work out better for most Medicare beneficiaries because it does not conflict as much with the holidays. In the past the November 15th through December 31st AEP time has caused many beneficiaries to miss out because they have been traveling for the Thanksgiving and Christmas holidays and with the hectic schedules many people have during this time they are not able to make an informed decision or they completely forget about being able to make changes to their insurance. This new time will be earlier in the year and it isn’t so close to both holidays, many people will have plenty of time to review their plans and make an informed decision about what they want to do for the new year. The new AEP time frame is going to cause insurance companies to have to change some business practices though. In the past the insurance companies did not have to have their new year plan info submitted to the Centers for Medicare & Medicaid Services (CMS) until June so they could be approved. With this change causing the enrollment period to be earlier, the companies are going to have to get to work earlier on creating their new plans for the year coming up to make sure they can have them submitted on time for approval. Also, most companies do not start training their sales and service agents for the new year plans until September since the plans were not released until October for customers to view. Assuming the same time line will apply and the new plans need to be available for members to view the new plans will probably need to be released in September starting in 2011. The insurance companies are going to have to start planning for training and start the actual training classes earlier in the year to be able to have their agents prepared for the earlier enrollment period. Overall the new AEP time frame will be more of a benefit for everyone, insurance companies and member alike, as long as everyone is well prepared.
The best thing for everyone to do at this point is to become familiar with the new enrollment time frames so no one is left out if they need to make changes. Beneficiaries need to start their research as early as they can so they can make a well informed decision on what they want from an insurance company. They also need to make sure they read their Annual Notice of Change Letter when they get it to see what changes may occur in their current plans. This is a major issue we come across within our industry, people get so much mail that they think that all of it is advertisement and throw it away not realizing it is important information about the changes to their plans. If you have a family member the is on Medicare or is going on Medicare soon make sure they know of the changes to the enrollment periods so they are prepared.