Medicare Advantage Plans – Will CMS Get It Right This Time?

In a recent conversation, the question was posed as to whether the Healthcare.gov portal would be able to serve as a platform for transition to the new Medicare Advantage plans for senior citizens. That question was based on information that appeared on the government’s website as of early January. We asked why the Medicare supplement program’s IT department had not made these announcements just months ago, and when would they be required to do so?

Indeed, a good question. And I’ll address that in a moment. Let’s look at the current situation now and see how we can best transition to the new Advantage plans. To begin with, the website reflects new plans which will go into effect in 2020. Review Medicare Advantage plans 2020

How will these new medical plans affect your plan? For those of you who are currently covered by a traditional Medicare supplement plan (one which combines physician’s fees and other out-of-pocket costs), then you should have no problems finding a new plan to replace your existing one. The portal does allow you to make changes to your existing coverage before switching to a new plan.

If you don’t have supplemental coverage, then you will likely find yourself enrolled in a new plan using the Medicare Advantage plans that will begin in 2020. Yes, that’s right. In addition to having to decide which provider to select from the list of hundreds, you also will need to decide whether to pay all or part of the monthly premium, and if you choose the latter, you will need to know how much it will cost you.

As previously mentioned, the Healthcare.gov portal has been designed to help assist with the transition to the new Advantage plans. This program works through the federal Centers for Medicare & Medicaid Services (CMS) to connect Medicare Advantage plans with consumers, making it possible for seniors to navigate their coverage choices. These websites are also designed to provide assistance with understanding coverage rules and limitations, ordering private coverage, requesting information and benefits, and enrolling.

CMS has provided key facts about the program on its website, and we’ve also gathered additional data from the various websites that are part of the program. The following summary outlines CMS’ views as it relates to the rollout of the new programs:

CMS describes the program as a way to “remain in the program, while receiving affordable and quality medical coverage.” They see the program as a means to “help seniors and people with disabilities remain in the program.” CMS also described the program as being an opportunity for consumers to “seek care from an experienced provider.” There are also provisions to help seniors “achieve better health.”

The new plans, however, are a relatively new concept in the U.S. and as of the time of writing, they are still being implemented. Those of you covered under a traditional Medicare supplement plan will need to make sure that you receive appropriate notice of the program changes, and to make sure that you can continue your coverage without any problems.

If you feel that your provider has not been given adequate notice, then you should call them up and arrange to have a meeting in the doctor’s office or hospital. You should also get in touch with your insurer to let them know that you are changing to the new plans. When you’ve got both the provider and your insurer on board, it is time to negotiate your coverage and costs.

Healthcare.gov and CMS also recommend that you contact your individual insurance companies to inform them of your new coverage. Do this by requesting information on the new plans, including the new premium prices, and informing your company of your decision to switch.

You should also ask your agent about the plan options and premiums that you might want to consider. Although these plans are not yet official, CMS advises that your agent should inform you about the new plans, if you request their advice, so that you can begin to explore your options.

So, as of the time of writing, the Healthcare.gov portal is set up to help senior citizens and their families to transition to these new plans. But I’d still recommend that you check with your insurance agent and policyholders to see what kind of coverage you can qualify for and what the coverage terms are for the new plans.