Congress must address Medicare needs

By Janet Trautwein

Over 18 million seniors just picked a Medicare Advantage plan for next year. Let's hope they chose wisely. Because if they selected a benefit package that turns out to be a bad fit, they're likely stuck with it.

That didn't used to be the case. Up until a few years ago, seniors had an opportunity to switch plans in the first weeks of the new year if their budgets or health circumstances changed.

Medicare Advantage is more popular than ever. The program allows seniors to pick from a variety of privately administered insurance plans that provide dental, vision and prescription drug benefits in addition to coverage for hospital procedures and doctor visits. Enrollment has increased from less than 6 million a decade ago to more than 17 million in 2016. The Congressional Budget Office projects that more than 40 percent of all seniors eligible for Medicare will enroll in a Medicare Advantage plan by 2017.

Seniors select their Medicare Advantage plans during an "annual election period" each fall. Throughout this period, they can change Medicare Advantage plans, continue with their current plan or return to traditional Medicare.

But as of Jan. 1, their decisions are all but locked in for the rest of the year.

This wasn't always the case for seniors. During a 90-day "open enrollment period" following Jan. 1, seniors could choose a new Medicare Advantage plan if they decided that the one they'd previously selected wasn't a good fit for them.

The Affordable Care Act eliminated this open enrollment period. Instead, the law offers a poor substitute - an "annual disenrollment period." For the first six weeks of the year, seniors can exit their Medicare Advantage plans. But they must then enroll in traditional Medicare. They can't pick a new Medicare Advantage plan.

This lack of flexibility can have real negative consequences for seniors. For instance, some seniors might not realize the benefits and providers covered by their Medicare Advantage plan have changed from one year to the next - until they walk into their doctors' offices and have their insurance cards denied.

Others may be unaware another Advantage plan has lower premiums and deductibles, or more valuable benefits, until a friend informs them of other options.

Before the Affordable Care Act eliminated the open enrollment period, seniors who enrolled in a plan for Jan. 1 could "test drive" plans - and then could make a one-time switch if they found the plan was not a good fit. A survey conducted by my organization, the National Association of Health Underwriters, found many seniors who switched coverage during open enrollment did so because friends or relatives furnished them with additional research about coverage options that better suited their particular needs.

Low-income seniors have been hit particularly hard. Without the open enrollment backstop, many find themselves stuck in a Medicare Advantage plan that doesn't provide adequate or affordable coverage. And their only other option is to switch to traditional Medicare, which doesn't cover the dental and vision procedures they may need.

Fortunately, Congress is considering restoring seniors' freedom to make a one-time switch to another Medicare Advantage plan. Restoring this pre-ACA provision would prevent them from inadvertently getting trapped in a plan that does not meet their health care needs or is not in their best financial interest - and prove that Congress truly is "open" to meeting seniors' health care needs.

Janet Trautwein is chief executive officer of the National Association of Health Underwriters.

Credit: By Janet Trautwein For the Deseret News