Medicare May Help Seniors If Advantage Plans Drop Doctors

Next year, seniors with private Medicare Advantage insurance policies whose doctors leave their plan may be able to leave, too, under a new Medicare rule. The Centers for Medicare & Medicaid Services (CMS), which oversee Medicare Advantage programs, will create a special three-month enrollment period in any state where insurers make network changes “considered significant based on the affect or potential to affect, current plan enrollees,” according to an update to Medicare’s Managed Care Manual. The special enrollment period – if granted by CMS – would allow Medicare Advantage members to switch out of their plans and join traditional Medicare or another Medicare Advantage plan whose provider network includes their doctors. The mid-year special enrollment period wasn’t an option in 2013 when more than 32,000 UnitedHealthcare Medicare Advantage members in Connecticut were affected by the company’s decision to drop thousands of doctors from its network of providers. The Fairfield County Medical Association sued the company to stop the terminations but was ultimately unsuccessful.

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