Client Questions:
1. Do I need to be enrolled in Medicare Part B (Medical) if I have a Medicare Advantage plan?
Coach: Yes, enrollment in Part B is a requirement to be eligible for Supplement and Advantage plans.
2. Client: If one opts out of Medicare Advantage, who handles the claims? The Government or the Private Company?
Coach: Claims for those on Traditional Medicare are handled by the Governments’ designated Claim representative. For Kansas, claims are handled by: Wisconsin Physician’s Service of Madison, WI. Claims for those on Advantage plans are handled directly by the Private Insurance carrier.
3. Client: If a person initially takes a Medicare Advantage plan, is there an opportunity to later switch to standard Medicare with a supplement plan? If a switch is possible, would there be a penalty for switching?
Coach: You can join, switch, or drop a Medicare Advantage plan at these times: Between Nov 15-Dec 31 each year. Between Jan 1-March 31 of each year. In most cases you must stay enrolled for that calendar year starting the date your coverage begins, but there are exceptions like moving out of your plan’s service area.
There are no penalties for switching from Advantage plans to Traditional Medicare. But………………….!!!!!
Here’s the danger of joining an Advantage Plan: You can return to Original Medicare without evidence of insurability if you return during the first 12 months from your enrollment date. After that period, there are no guarantees. I have a 53 year old client who was disabled and enrolled himself in a Medicare Advantage plan on line. After multiple hospitalizations and big medical co-pays, his sister called me to get him back to Original Medicare. He lost his guaranteed insurability option to return because he did not request it during the 12-month window, and will not be able to exercise his guaranteed enrollment in Traditional Medicare until he reaches age 65. The client made a costly mistake in this case.
Coach
PS: Medicare Advantage is geared for Metro areas with large population centers like Dade County in Miami, and Orange County California. Rural areas have limited access to these plans. So some of my rural Kansas clients on Traditionl Medicare refer to the program as “Medicare Dis-Advantage” because the Advantage plans are heavily subsidized by the Federal government. Advantage plans receive about 14% more per beneficiary from the government than Traditional Medicare beneficiaries. We’ll have more on that later.
