This morning I received a call from the spouse of an individual with multiple medical conditions. Because she is on a Medicare Advantage plan, her treatment facilities are limited to those that the medical group she is with has contracts. The spouse has located a new doctor outside of the plan whose treatment of his wife has resulted in visible improvements for her.
The spouse would like to take his wife out of the current Medicare Advantage plan and place her onto a Medicare supplement/medigap policy. However, under Medicare that change cannot be selected until Annual Enrollment (Oct. 15-Dec 7) and would not be effective until 1/1/14.
Medicare supplements/medigap policies have health history underwriting requirements that will need to be addressed should they select to opt out of a Medicare Advantage plan onto a Medicare supplement and a stand-alone drug plan.
In the interim, he would be able to have his wife meet with the new physician as a private pay (out-of-pocket responsibility by the beneficiary).
Take the time during Annual Enrollment to review your plans’ benefits for the upcoming year.