If you’re enrolled in a Medicare Advantage plan—or helping a parent or loved one who is—you could be facing important changes to coverage and costs without even realizing it.
Many people only discover these changes at the doctor’s office, when they’re told a service is no longer covered, their plan has been discontinued, or their hospital is suddenly out of network.
To help unpack what’s happening and what you can do about it, we spoke with Jeannine Linstrom, a Licensed Insurance Agent and owner of RJ Premier Benefit Advisors. Jeannine works with more than 800 clients, over 500 of whom are enrolled in Medicare Advantage plans.
Why So Many Changes in Medicare Advantage?
In short, the funding environment is changing.
Medicare Advantage plans are funded by the federal government through the Centers for Medicare & Medicaid Services (CMS). Each year, CMS determines how much funding will be allocated to these plans. “The biggest challenge in recent years is that the amount allocated to these plans is not keeping up with inflation and utilization,” Jeannine notes. “People on these plans are living longer, they have more health issues, and they’re using their benefits more than ever.”
As a result, some plans are reducing supplemental benefits, adjusting copays, or changing provider networks. Unfortunately, many beneficiaries don’t learn about these changes until they affect their care.
The Most Important Document You’re Probably Ignoring
The single most important thing you can do to avoid being blindsided is to carefully review your Annual Notice of Change (ANOC).
Medicare Advantage members receive this document each fall—typically in September—and it explains exactly what will change in their plan for the following year.
“Many people get the ANOC, and they never look at it,” Jeannine says. “Then they say, ‘I didn’t know this was changing.’ Every carrier sends this out. By law, they have to. You should go line by line and look at the changes.”
Ignoring that packet can lead to unpleasant surprises at the pharmacy, doctor’s office, or hospital once the new plan year begins.
Plan Exits and Network Changes
Jeannine has seen entire plans—and even major carriers—exit specific regions.
“Blue Cross Blue Shield stopped offering Medicare Advantage plans in the Kansas City area,” she notes. “Some plans have exited specific counties because there wasn’t enough membership to make it viable.”
Fortunately, plan exits generally do not happen in the middle of the year. They take effect during the annual enrollment period, giving members an opportunity to select new coverage.
The problem is that many people don’t read the notices informing them of these changes. As a result, some come dangerously close to losing coverage without realizing it.
Network changes can be even more disruptive.
“A major hospital in the Kansas City area dropped a Medicare Advantage plan mid-year, and it left people scrambling,” Jeannine recalls. “A hospital that was in-network was suddenly out of network.”
The Growing Threat of Scams
Alongside legitimate plan changes, Jeannine is increasingly concerned about scams targeting older adults, particularly those in their 80s and 90s.
She recently worked with a man in his early 90s who discovered at his cardiologist’s office that he had suddenly been switched to an HMO plan that required referrals.
“He said, ‘I’ve been coming here for years. I’ve never needed a referral.’ He called us and said, ‘I didn’t change my plan,’ and we certainly didn’t. We kept him on the PPO for that specific reason.”
Jeannine believes he likely fell victim to a phone-based scam.
“If you answer the phone and they say, ‘Is this Mr. Smith?’ and you say yes, AI can duplicate that ‘yes,’ ask questions, record you saying yes, and then suddenly switch your plan. Many people don’t recall even having a conversation.”
Her advice is straightforward:
- Don’t answer calls from numbers you don’t recognize.
- Never discuss your Medicare information with unsolicited callers.
- Assume that if a call is important and legitimate, the caller will leave a message.
Three Key Actions to Protect Yourself
What can you do to protect yourself or a loved one?
Jeannine recommends three simple but important steps:
1. Read Your ANOC Carefully
Review your Annual Notice of Change line by line each year. Understand what’s changing and adjust your plan during the Annual Enrollment Period (AEP), which happens each year between October 15 and December 7.
2. Meet with a Trusted Local Advisor
Meet with someone you trust who will explain everything in clear language. A knowledgeable, licensed broker can help you understand what you have and whether it still fits your needs.
3. Stay Alert for Scams and Misinformation
There is a tremendous amount of fear-based and inaccurate information circulating through phone calls, television advertising, direct mail, and social media. If you have questions about your health insurance, don’t look for answers in unsolicited communications. Your best bet is to contact your plan directly or speak with a trusted advisor.
If you’re helping aging parents or relatives, stay involved in the process. Understanding their coverage and reviewing plan communications together can help you spot problems before they become crises.
Jeannine Lindstrom, Licensed Insurance Agent, can be reached at 816.309.5615, www.MedicareSolutionsABC.com, or info@MedicareSolutionsABC.com
Not connected with or endorsed by the U.S. Government or the federal Medicare program.
Recent Comments