Even when Advantage enrollees are able to confirm participation by their healthcare providers, there is no guarantee that will continue. Advantage plans are free to add or drop health providers during the course of an enrollment season.
That became an especially hot issue in 2014 when UnitedHealthcare dropped providers who covered thousands of the insurer’s patients, including the prominent Yale-New Haven Hospital system.
Democrats in Congress have proposed legislation that would prohibit Advantage plans from dropping providers without cause during the middle of an enrollment year.
Under current rules, plans must provide 30 days’ notice to enrollees when providers are dropped. Enrollees who lose access to a provider can make a midyear plan change only under very limited circumstances. “You can do it only if you are receiving ongoing care from a provider that is terminated,” Jacobson said. “Otherwise you need to wait until the next open enrollment period.”
The annual enrollment period for Advantage and Part D prescription drug plans are held from Oct. 15 to Dec. 7 each year. At that point, a beneficiary could switch to a different Advantage plan, or shift back to traditional Medicare. But a serious diagnosis in January would leave you hamstrung until the following year.
Said Jacobson: “It can be a roll of the dice.”
(The opinions expressed here are those of the author, a columnist for Reuters.)