| Tue, Oct 25, 2011 @ 09:00 AM

Can Medicare Advantage Plans Refuse to Cover Me?

Posted by Medicare Made Clear

To join a Medicare Advantage plan, eligible individuals must first be enrolled in Medicare Part A and Part B and be paying their Medicare Part B premiumIn 1997, Medicare Advantage (Part C) plans were created to give Medicare members the choice to receive coverage through private insurance company plans or through the federal government’s program. Original Medicare, the federal program, offers inpatient hospital coverage (Part A) and outpatient medical coverage (Part B). Medicare Advantage plans bundle coverage for hospital stays with coverage for doctor visits, preventive care, and things like vision and hearing exams. Many also include prescription drug coverage.

Can I Join a Medicare Advantage Plan?

To join a Medicare Advantage plan, you must first be eligible for Medicare and enrolled in Original Medicare (both Part A and Part B). You must continue to pay your Medicare Part B premium to remain enrolled in a Medicare Advantage plan.

Medicare Advantage plans that are accepting new members in your county, state or region (a plan’s “service area”) cannot delay or refuse coverage to people who qualify for Medicare. Each company’s service area is different, and not all plans will accept new members, so check with the administrator of the plan you’re interested in for specific coverage information.

The Medicare.gov plan finder tool can help you find plans available in your area.

Pre-Existing Conditions and End-Stage Renal Disease (ESRD)

You can join a Medicare Advantage plan even if you have a pre-existing condition, but there are special requirements if you have end-stage renal disease (ESRD). If you have ESRD, you will usually get your health care through Original Medicare rather than a Medicare Advantage plan. The “Medicare Coverage of Kidney Dialysis and Kidney Transplant Services” booklet offers more about Medicare coverage choices for individuals with ESRD.

Join a Medicare Advantage Plan During the Annual Enrollment Period (AEP)

When you’re eligible for Medicare, you may enroll in a Medicare Advantage plan during your Initial Enrollment Period (the three months before, during and after your 65th birth month). Or you may join or switch to a Medicare Advantage plan during the Annual Enrollment Period. In 2011, the Annual Enrollment Period goes from October 15 through December 7. Changes made during this time go into effect on January 1.

If you choose to enroll in a Medicare Advantage plan accepting new members in your service area, you may enroll by contacting the insurance company that administers the plan. Many insurance companies have online or telephone enrollment, or they can mail you materials. Changes to Original Medicare plans go through your local Social Security office.

For more information contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact UnitedHealthcare® Medicare Made Clear to learn more 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


Understanding Medicare Part C – MedicareMadeClear.com

CMS’ Medicare and You – Medicare.gov

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