The Pitfalls of Leaving Original Medicare & Supplement Plan for Medicare Advantage HMO

Phil Lee — Tue, 27 Oct 2015 00:58:35 +0000

(This information concerns Medicare Health Plans. It does not concern you if you are either on an Employer-Sponsored Group Health Plan or on an Individual & Family Health Plan)

We frequently hear stories about seniors who made this change hastily because they attended a meeting, or an agent came to their home. Frequently these agents would represent a limited number, usually just one, Medicare Advantage HMO plan. They typically do not give prospects an adequate overview or understanding of the entire universe of plans in the marketplace because they have limited knowledge and products to offer. They don’t fully explain the consequences of your making such a switch.

If you are contemplating such a change, you should not do so lightly. You should only do this after much thought and research. It’s not a matter of simply changing plans or changing carriers. It’s nothing short of changing from one world of plans, Original Medicare with Medicare Supplement, to another entirely different world of plans, Medicare Advantage.

These are the issues you must consider:

This change may not be reversible in the future because Medicare Supplement plans are not guarantee-issue, except at age 65. Supplement plans do not have an annual open enrollment period as Advantage plans do. If you ever want to go back to Medicare Supplement from an Advantage plan, you will have to be medically underwritten and approved on your application before you will be enrolled.
90% of our clients choose Medicare Supplement F plans because of the freedom to choose their own providers anywhere in the country, and also because of the freedom from Copays, Coinsurance and Deductibles for all medical costs, excluding Rx. However over the years, many non-clients have approached us for help to make the difficult transition from Medicare Advantage, such as Kaiser back to Original Medicare and Supplement. This process is not easy, and is full of tricky timing and health approval issues.
Medicare Advantage HMO plans like Kaiser Advantage or Scan Health require you to use only those doctors that are in their network. You will not have the option to see any outside doctors such as from UCSF, Stanford, etc. You will be required to obtain referrals and authorization for all specialists, procedures, etc.
Advantage plans do not include Foreign Travel benefits.
Kaiser Medicare Advantage does not cooperate with independent agents. So we will not be able to service you on your Medicare plans at all.
CMS (Center for Medicare & Medicaid Services) has ruled that Medicare Supplement F plans can no longer be offered to new enrollees after the year 2020. If you think you might want a Medicare Supplement F plan in the future, you must enroll before 2020.
Medicare Trial Period and Medicare 24 Month Rule – Under very limited circumstances, Medicare beneficiaries who enroll in an Advantage plan at age 65 may have a 12 to 24 month Medicare Trial Period where they may switch back to Original Medicare, a Medicare Supplement plan and a Medicare PDP (Rx) plan, guarantee-issue. But it must be done within 24 months from age 65 Medicare ICEP (Initial Coverage Enrollment Period).

Phil Lee

Lee Health Insurance Services
800-286-7445