3 Questions About Enrollment Periods And More
I get a ton of questions from our clients and friends, and I try to generalize them and answer in a blog post to share as widely as possible. We just finished the speed dating season of the Annual Enrollment Period (AEP) from October 15th through December 7th, and we are now in the Open Enrollment Period (OEP) and General Enrollment Period (GEP) from January 1st to March 31st. Faded football players and shopworn TV Stars are back, flooding your CNN (or CNBC) broadcast with Medicare solicitations.
Key Enrollment Periods – Dates to Remember
- Annual Enrollment Period (AEP): October 15 – December 7
- Open Enrollment Period (OEP): January 1 – March 31
- General Enrollment Period (GEP): January 1 – March 31
Question #1: What are these enrollment periods, and should I pay any attention?
Let’s look at Open Enrollment (OEP) first. Open enrollment is what I call the oops enrollment period; as in I made a mistake and I need to get out of this Advantage Plan now! This happens all the time – sometimes due to unscrupulous salespeople, but more frequently due to changes in physician participation, formulary, in-network pharmacies, and the like.
OEP only applies to people already in Advantage plans and Part D drug plans. If you have only Part A and B, or a Supplement, OEP does not really apply to you.
I have moved a couple of people out of their existing plans during the OEP this year, and will probably move a few more, but in general I regard moving people during this period as unfortunate, and perhaps a failure in planning and selection. If you think that you have made a mistake, however, now is the time to fix it. If you want to get an Advantage plan, and don’t have one – you can look at a Special Enrollment Period like moving into a 5 Star Plan, but in general the OEP will not help.
The General Enrollment Period (GEP) is really important if you have put off participating in Part B. GEP is when you can get into Part B, select a Plan after April 1st, and have full coverage beginning July 1st. Remember, Medicare only provides emergent/urgent coverage outside the US through certain Supplements or Advantage plans – and you need to be in Part B to get either one.
Question #2: Do I have the best plan available to me? Why can’t I get the Advantage plan I want?
First, is the easy part – if you have a Supplement (Plans D,G,N or M), and routinely spend less than 60 consecutive days outside the US, you have the right coverage – don’t change a thing.
You have great coverage in the US and emergent care outside the US – go have fun. If you have a Supplement and routinely spend more the 60 consecutive days outside the US, then you don’t have emergency coverage outside the US. You should consider an Advantage plan that offers worldwide coverage. Most Advantage plans offer coverage for up to 6 months outside your home market (US residence) with coverage capped at $50,000. There are plans now offering and more than 6 months out of you home market and much larger coverage limits – so it really pays to shop around.
Second, is the hard part – why can’t I find the Advantage plan that I want?
This is a really hard question, with a complex answer. Advantage plans thrive in densely populated markets with high levels of medical competition and low levels of state regulation. Advantage plans are based on manage care models, and require competitive choice of comprehensive medical networks to be successful. The most competitive (and best for consumers) markets for Advantage plans are normally densely populated areas with limited additional regulation at the state level and at least 3 competing medical systems. Geography is destiny when it comes to Medicare choice, as illustrated by the table below. The venues were chosen based on where we have lived, and where we have friends and family, and where there is a range of costs and choices in Advantage plans.
Medicare Advantage plans go where they see opportunity and stay where they make money. Accordingly, the choice of Advantage plans is much greater in Nashville than New York City. But plan design and program cost are at least as important to the consumer as choice, and price and terms available in the smaller and more highly regulated markets are generally less attractive than larger competitive markets. Many of the smaller and “less hospitable” markets are dominated by a single health system that limits competition and increases the price.
My advice to retirees is to carefully consider where they want to have their residence.
The Go-Go years of retirement bring opportunities for flexibility. Retirement means the ability to choose where you want to spend your time and declare your residence. Access to medical care is frequently cited as an important factor – but how you pay for that care depends on the available Medicare Plans – make Medicare cost and flexibility part of your planning and selection process.
Question #3: What factors should I consider when thinking about participating in a medical evacuation program?
First, the easy part – if you spend time outside the US you should participate in a medical evacuation plan. These are typically membership programs – not insurance, but they provide a critical function in getting you home when you are sick or injured abroad. Programs range from short term (8 days) to 365 day per year programs for real expats, with prices ranging from around hundred dollars to $2,500 for multi-year evacuation programs including security and civil unrest.
These programs are not travel insurance – they are not for lost baggage, missed flights etc. They are for one thing only, to get you out of the hospital abroad, and to your hospital at home. These are very low probability events, but very expensive if you have no program protection, which makes program participating at a reasonable cost compelling.
We represent Medjet – a selection that we made based on their experience, scale, and reputation. Medical evacuation is a really hard thing to do – it involves foreign venues, medical requirements, transportation, crew, and medications. They move a patient from a foreign hospital to their hospital back in the US, and they do so, “regardless of medical necessity”. In effect, they are not in the business of determining how sick you are – if you are in the hospital, they will come to get you. This relieves a lot of potential discussion but does require that you be in a hospital – and this is an important point. If you are an outpatient, you can make it home on your own. If you are at 16,000 feet on Mt Kilimanjaro, you need to get down and into a hospital.
There are other very reputable companies that will get you out of the jungle, off a mountain or from a raft at sea (if you can get telephone service) – but that is not really our clientele. Our folks are retirees concerned about accidents, heart attacks, strokes, and communicable disease. And there is no one that we feel more comfortable with than Medjet for those circumstances.