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Medicare Open Enrollment Period Problems

Medicare's open enrollment period gives Medicare recipients an opportunity to make changes to their current health care coverage. With the advent of the Patient Protection and Affordable Care Act of 2010, changes in Medicare plans and their availability may cause problems for certain Medicare recipients who wish to make changes in their health care coverage.

  1. Open Enrollment Period Changes

    • As the costs of health care change from year to year, these changes affect the price tags attached to Medicare plans and the types of coverages each plan offers. Annual open enrollment periods allow Medicare recipients to take advantage of more affordable plans and coverages. Prior to 2011, Medicare recipients who carried private plans or Medicare Advantage plans had the option of switching to another private plan during the open enrollment period which ran from January 1 to March 31. As of 2011, only private plan recipients who wish to switch from their current plans to traditional Medicare coverage, a Medicare supplement plan or change an existing prescription drug plan can do so during the January 1 to February 14 enrollment period. As insurers may change plans and coverages on a frequent basis, these changes may cause problems for certain Medicare recipients.

    Fall Open Enrollment Period

    • As of 2011, Medicare private-plan holders can switch insurance carriers or plans during the Fall Open Enrollment period, also known as the Annual Coordinated Election Period, which runs from October 15 to December 7. Any changes made during this period become effective as of January 1 of the following year. Medicare plan holders may run into problems, such as prescription coverage delays or plan coverage gaps if they wait until the last minute to make plan changes. In terms of private prescription drug plans, the Fall Open Enrollment period is the only time Medicare recipients can switch between plans.

    Medicare Supplement Open Enrollment Period

    • Medicare supplement plans---also known as Medigap---provide much of the same coverages as Medicare Advantage plans, but with more plan flexibility as far as coverage choices go. Open enrollment periods for Medicare supplements are based on when a person turns 65-years old. Enrollment periods span seven months which include three months before the 65th birthday, the birthday month and three months after the birthday month. Medicare recipients may run into problems with enrollment if they wait until after their open enrollment period passes. During open enrollment, recipients have a guaranteed issue option that prevents insurance carriers from refusing coverage. Once the enrollment period passes, recipients are subjected to underwriting conditions that can significantly raise plan prices and even result in refusal of coverage.

    Exceptions

    • Changes in the health care industry have worked to eliminate policy or plan types that offer basically the same coverages. According to the NYDailyNews.com news site, as of 2011, the Centers for Medicare & Medicaid Services have reduced the number of Medicare Advantage plans by 13 percent through elimination or consolidation of plan types, while prescription drug plans saw a 13 percent reduction. As a result, an extension has been granted for Medicare recipients whose Advantage plans were eliminated. Instead of the October 15 to December 7 time period, these recipients have until January 31 to switch to another Advantage plan. In cases where no plan changes are made, recipients will be automatically enrolled in a traditional Medicare plan.

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