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Special (Dis)Enrollment Period for Medicare HMOs Ends Dec. 31

  • December 19th, 2001

Individuals who are currently enrolled in Medicare HMOs (also called Medicare+Choice or managed care) plans have until December 31 to decide whether to leave their plan and return to regular Medicare, as well as to purchase certain Medigap policies with no pre-existing condition exclusions.

HHS Secretary Tommy G. Thompson declared the month of December a 'Special Election Period' to give Medicare beneficiaries more time to decide what type of health plan option they wish to have in 2002. Beneficiaries' right to drop out of a Medicare HMO at any time was scheduled to end in November, but HHS extended the deadline after it gave the HMOs themselves more time to decide whether to leave the Medicare program. Beginning January 1, 2002, beneficiaries will be able to exit a Medicare HMO plan only during the plan''s open enrollment period.

When the HHS Secretary declares a Special Enrollment Period, all enrollees in Medicare HMO plans have a guaranteed right to Medigap plans A, B, C or F--none of which offers a prescription drug plan. (A Medigap plan is a supplemental Medicare policy that beneficiaries may use to help pay for services not covered under fee-for-service Medicare.) The only requirement is that the beneficiary must leave the health plan they are currently enrolled in no later than December 31. If a beneficiary chooses to purchase a Medigap policy, the policy must be bought by March 4, 2002, 63 days after their coverage in the Medicare HMO plan ends.

For more details on Medicare and Medigap from ElderLawAnswers, click here.

Meanwhile, House Committee Debates Medicare+Choice Program

On December 4, the House Ways and Means Committee held hearings on the Medicare + Choice program, which has lost about 800,000 enrollees since 1997, mostly due to HMO plans dropping out of the Medicare program. Seniors are 'anguished, upset, frustrated and angry by the demise of those plans,' committee chair Nancy Johnson (R-CT) told Centers for Medicare & Medicaid Services Administrator Thomas Scully.

Scully testified that if Congress doesn't fix the problems with the Medicare+Choice program, it will 'blow away in the wind in the next few years.'

That prospect didn''t seem to bother Rep. Pete Stark (D-CA): "[I]t''s perhaps time that we recognize that less than 15 percent of the seniors have signed up for these Plus Choice plans. They have caused more problems than all the rest of Medicare put together. The premium support plan that the Medicare Commission came up with is a blatant attempt to shove people into these Medicare Plus Choice plans. So when you don''t have one in eight people who like them, why don''t we just can them, use the money to support the Medicare system, provide perhaps a federal Medigap policy that would cover all of our beneficiaries fairly? And, one of these days, we might even get around to a drug benefit, if we stop giving big tax breaks to wealthy people."

To download the full text of the testimony at the hearing in PDF (Adobe Acrobat) format, click here.

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Last Modified: 12/19/2001

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