Editorial: Medicare improves rule for some Medicare Advantage plans

Published 12:00 am Wednesday, December 31, 2014

The new year brings with it good news for older Americans who purchase Medicare Advantage insurance rather than the original government-run Medicare. In some cases they will be able to change plan providers midyear, rather than wait for the annual election period that runs from mid October to early December.

Medicare Advantage plans cover some 15.7 million seniors, nearly 30 percent of all those on Medicare, according to the Heritage Foundation. Those who purchase Medicare Advantage insurance do so for a year at a time during the election period, and they may change plans at other times only under very limited circumstances, such as when a purchaser moves to an area in which his or her current plan is not available.

The insurer’s decision to drop clinics or other provider groups has not been among the conditions in which plan purchasers can look for new coverage, however, and that’s been a problem. In Connecticut, for example, UnitedHealthcare/AARP cut 1,200 physicians in a single practice early this year, leaving thousands without coverage for doctors they had relied upon and without the ability to change insurance plans until late this year. Similar cuts happened in nine other states, as well.

Had the cuts been scheduled for February 2015, things might have been different. Starting next year the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees the two programs, will have the power to create special three-month enrollment periods when Advantage plans cut their ties with clinics.

That doesn’t mean that all those who find their doctors are no longer covered by their Advantage plan will be able to move at will. CMS will make that decision on a case-by-case basis, Kaiser Health News says, and it will consider such things as the number of people affected by a change, the plan’s service area size and the number of other providers available.

From a patient’s standpoint, the change is far from perfect, for some unknown number of providers are likely to be dropped with no special enrollment period available to their patients. Still, it’s better than nothing — a small but badly needed improvement.

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