Medicare Advantage Open Enrollment: Was Your Senior’s Doctor Dropped?

Ahhh, November, that time we look forward to Thanksgiving, holiday sales — and Medicare open enrollment for our senior loved ones.

Okay, maybe not so much the last one but it’s upon us none the less.

Open enrollment season isn’t a big deal for many seniors, who often are pleased with their own Medicare Advantage plans.

Pleased, maybe, but always wishing the premiums could be lower, right?

Research Before Advantage Plan Renewal

It always makes sense to check out the available Advantage Plans before making a decision. Plan details and pricing are always changing, with healthcare reform driving even more changes than we normally see from year to year.

A plan that didn’t look as good might be better now — and that top choice of a year ago could be an also-ran now.

There’s a new concern to take into account this year, though, as we can’t assume the doctors and other healthcare professionals who provide our senior loved ones’ care will be part of their plan next year. That possibility is always there, of course, but it bears watching even more closely now.

Doctors in several states have already been informed of their termination from Advantage Plan networks of the nation’s largest provider and that’s likely to be just the beginning. Early signs are that others are cutting to a lesser degree, at least for now, but it really pays to check before renewing or changing plans.

We can’t simply assume a provider who was on our senior loved one’s plan for this year will be in the future.

Checking Now No Guarantee

The status of many providers may not be known before Open Enrollment closes on December 7. Appeal options in insurers’ termination processes mean that things may still be very much up in the air by then.

What does this mean to our seniors?

Notice that their physicians have been terminated from seniors’ plans may arrive into the new year and after plan commitments have been made. The US Centers for Medicare and Medicaid services are keeping an eye on the networks to ensure information is provided to seniors on a timely basis if changes are made, but that won’t stop changes from hitting our seniors.

If a senior’s doctor is dropped from their plan during the year, it will likely mean finding a new doctor. That can be tough at any time, but much more so for those seniors with health problems requiring regular care. Having to change physicians can add to an already stressful situation so your older loved one might benefit from a family caregiver stepping in to aid in the process.

There’s also the issue of getting medical records, including test results, transferred to the new providers. That process still is not as straightforward and quick as many would like — and hopefully as it will be in the not too distant future.

Why Doctors are Being Dropped Now

Insurance companies receive a fee per person insured to manage the benefits under their Medicare Advantage programs. That fee is being cut over time, meaning the insurers have to cut costs somewhere or take a hit to their profitability.

This means we may see more providers cut from plans in coming years as well and, with those cuts, decisions regarding whether to change doctors or potentially pay the full bill for those our seniors want to keep.

It also means we may, as family caregivers, need to be ready to step in and assist our senior loved ones make what may be difficult transitions.