With Medicare’s annual open enrollment period ending on Dec. 7, now is the time for Medicare Advantage enrollees to ensure that their doctors and hospitals still participate in their plan. During this period, beneficiaries have the option to select a new Medicare Advantage plan, a new Part D drug plan, or switch from original Medicare into Medicare Advantage and vice versa. It’s crucial to review your plan’s provider network every year and confirm that all your healthcare providers are still in-network for the upcoming year.
The significance of this verification process has increased recently as some major U.S. health systems have chosen to cancel or plan to cancel their contracts with Medicare Advantage, according to Becker’s ASC Review. For instance, two physician groups affiliated with San Diego-based Scripps Health have filed termination notices with Medicare Advantage plans used by thousands of patients in San Diego County. These changes are set to take effect on Jan. 1, 2024.
Tricia Neuman, the executive director for the Program on Medicare Policy at KFF, a nonprofit health policy organization, emphasizes the importance of ensuring that the doctors, specialists, and hospitals that matter to you are within the network of your preferred plan. To confirm this, it is recommended to directly contact the doctor’s office as online provider directories may not always be up to date.
Medicare Advantage, which is managed by private insurance carriers in partnership with the government, covers bundled Part A inpatient hospital coverage, Part B outpatient coverage, and often Part D drug coverage. Approximately half of the nation’s 65 million Medicare beneficiaries are enrolled in Medicare Advantage. In contrast, original Medicare (also referred to as traditional Medicare or fee-for-service Medicare) is administered solely by the government and does not have a network of participating providers. Beneficiaries with original Medicare can visit any doctor or hospital in the country that accepts Medicare.
Stay informed and make sure your healthcare providers are aligned with your Medicare Advantage plan to ensure uninterrupted access to quality care.
The Consequences of Canceling Medicare Advantage Contracts
Canceling Medicare Advantage contracts can have serious consequences for both health systems and patients. According to Neuman, the health system risks losing patients and revenue, while patients may lose access to trusted providers and experience disruptions in their care.
Reasons for Terminating Contracts
Denial of Coverage
Switching Back to Original Medicare
Open Enrollment and Planning Ahead
For those on Medicare Advantage, there is an opportunity to switch plans during the annual Medicare Advantage open enrollment period from January 1st to March 31st. However, it is advisable to do the necessary research now to avoid any unpleasant surprises in the upcoming year.
