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September 16, 2011 > HealthCare... Who Cares?

HealthCare... Who Cares?

By J. Dennis Wolfe

Before we talk about Medicare Open Enrollment, let me first respond to all of you who contacted me about my last column. Yes, I do believe the hospital could do better in its administration and financial management. However, I could make that comment about almost every hospital in the country. When any large entity such as a community hospital, serves the public, the public has an obligation to attend the entity's public meetings and voice their concerns. I stand by my praise of the care rendered and wish to make it clear that the two issues - hospital management versus hospital care - are different matters.

Now, onto the Open Enrollment Period (OEP) for Seniors. The most important date on any Senior's calendar is not when OEP starts, but rather when it ends. That has been changed to December 7th - NOT December 31st, as it has been for the last few years. OEP starts October 15 this year. In previous years it began on November 15. Last year the OEP ran right until the end of the year and caused mass chaos with paperwork flying between CMS and private insurers. So, in order to end it sooner (now December 7th), they had to start earlier (October 15th). Are you confused yet?

Well, just remember those two dates - OEP Starts on 10-15/2011 and ends on 12/07/2011!

During OEP you can disenroll from one Medicare Advantage (MA) policy and enroll into another one. You cannot disenroll from an MA policy and switch back to a MediGap without providing evidence of insurability. Of course, there are exceptions. Yes, it is complicated.

During OEP you can also move from one Part D prescription drug program to another. You can also switch to another Part D plan beginning January 1, 2012, ending on February 14, 2012.

Whatever MA medical plan change you make during the OEP, none matter except the last decision made prior to December 7th. The last decision as to which MA plan you select is what will become effective on January 1, 2012.

A huge note of caution to our Senior community - who do you trust to seek guidance when considering a change?

CMS - The Center for Medicare and Medicaid Services sets rigid guidelines for those of us professional brokers who seek to advise and sell MA products (with/without Part D). I have noticed fewer and fewer of my contemporaries who take the time to get certified and I understand why. It is a time-consuming process with several courses and tests required in order to become certified. I applaud this as it eliminates insurance salespeople and leaves the process to professional brokers. I am in the process, as of this writing, of working to complete the courses and tests.

So here is what you need to know. A professional, certified broker or even a large entity (such as a local senior center or a hospital) cannot hold a sales presentation and call it an "educational event." That is considered a "bait and switch" tactic under the guise of offering to help you better understand all of this. Large entities are handicapped even further and may still abuse the trust you place in them. They cannot talk about products and cannot refer you to brokers, either. The extent of their advice is exclusively limited to help you better understand Medicare. Further, they can only use CMS materials.

If you suspect you are being "led" to speak to a specific broker or feel that a particular product or carrier is being suggested, let me know. You are in control and no one should be abusing your trust in them by using their position of purported credibility in this way.

Be safe and secure. Ask the broker or the large entity to provide a copy of their AHIP certification and that issued by each carrier they represent to you. This is serious stuff. Only a few insurance carriers have the stability to even be in the senior market, which is why I am so adamant about this year's OEP and following the CMS rules. It matters!

Stay healthy. Stay tuned. Get involved. Learn what is being done. Your life now does indeed depend upon it.

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