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Home Health & Hospice Week

Regulations:

USE THESE REASONS TO HELP BENEFICIARIES DISENROLL FROM MA PLANS

Published on Tue Mar 18, 2008

Your patients aren't always stuck with a lemon of a Medicare Advantage plan once they sign on the dotted line.

Medicare beneficiaries can get around the one-year lock in certain cases, noted attorney Vicki Gottlich with the Center for Medicare Advocacy at the National Association for Home Care & Hospice's March on Washington conference. Those circumstances include:

• Nursing home residency. Nursing home residents can change plans at any time, including those going into and out of homes.
• Dual eligibles. Benes eligible for both Medicare and Medicaid coverage can also change plans at any time.
• Moving. The bene can change plans if she moves out of the plan's service area.
• Newbies. During Medicare beneficiaries' first year of enrollment, they may disenroll from plans.
• Insurance switch. Benes' may also disenroll during the first year if they dropped their Medigap insurance to enroll.
• Fraud. Although it's hard to prove marketing abuse versus a plain bad choice by a beneficiary, they can also disenroll for fraud.

The Medicare Advantage special enrollment periods that allow disenrollment are described in the Medicare Managed Care Manual, Chapter 2, Medicare Advantage Enrollment and Disenrollment, at www.cms.hhs.gov/HealthPlansGenInfo/Downloads/mc86c02.pdf, Gottlich notes on the CMA Web site.

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