Medicare Advantage Enters Do-Over Period

Northeast Mississippi Daily Journal (Tupelo)

Jan. 7--TUPELO -- When Carlton Jacobs signed up for a Medicare Advantage plan with Humana last fall, he didn't realize it was missing something.

When the New Albany man went for an appointment in Tupelo, he found that his doctor was out of network.

"If I hadn't had VA (benefits), I would have been in trouble," Jacobs said.

Jacobs was able to disenroll in the Medicare Advantage and return to traditional Medicare during the open enrollment period that ended Dec. 7. Seniors like Jacobs, who find themselves in a Medicare Advantage plan that doesn't quite fit, have a do-over period that runs through March 31.

People enrolled in Medicare Advantage plans have the option to chose another Medicare Advantage plan or return to traditional Medicare, said Wally Davis, North Mississippi Health Services vice president for managed care.

"These people can switch back with no penalty," Davis said.

Mississippi Insurance Commissioner Mike Chaney said his office received calls about aggressive marketing tactics for a Medicare Advantage plan this fall.

"We got to the bottom of it fairly quickly," Chaney said. "We put a stop to that."

Continued fallout

North Mississippi Health Services hospitals and clinics left Humana's Medicare Advantage network at the end of 2018. At the time, NMHS was not in network for any other Medicare Advantage plan available to Northeast Mississippi residents.

"It affected about 8,000 people," Chaney said.

Humana and NMHS have not been able to mend the rift. Seniors with Humana Medicare Advantage have to receive prior authorization for non-emergency services at NMHS, Davis said. The only exception is for Alabama state retirees, whose Humana Medicare Advantage plan covers in and out of network services at the same rates.

Other companies have begun offering Medicare Advantage plans in Northeast Mississippi.

Aetna nearly doubled the Mississippi counties covered by its Medicare advantage plan, going from 7 to 13 counties in North and South Mississippi, said Cynthia Follmer, Aetna's regional chief Medicare officer. In Northeast Mississippi, Itawamba, Tishomingo and Benton counties joined Marshall County with access to the Aetna Medicare Advantage plan.

Aetna already had a partnership with North Mississippi Health Services for its commercial insurance plans, and they signed a new agreement in late November to provide in network coverage for the Medicare Advantage plan.

United Healthcare, which also has a commercial partnership with NMHS, is offering a Medicare Advantage plan for those who are eligible for both Medicare and Medicaid, Davis said. In Northeast Mississippi, it is available in Alcorn, Benton, Clay, Lafayette, Lee, Marshall, Monroe, Oktibbeha, Pontotoc, Tippah and Union counties.

For 2021, there may be additional Medicare Advantage choices in the region. Insurers have to submit expansion requests in the spring.

"We see a lot of opportunity now that we have an agreement with North Mississippi Health Services," Foller said.

Davis said he's heard of at least one other insurer mulling plans to enter the market.

"We'll see where these discussions go," Davis said.

Medicare Advantage plans, which are managed by private insurance companies, typically offer richer benefits with caps on out-of-pocket spending, but members face higher costs if they go out-of-network.

With traditional Medicare, seniors are free to use any hospital or clinic that accepts Medicare. They have to sign up for a separate Part D prescription drug coverage. Because there is no out-of-pocket limit for traditional Medicare, people often purchase a separate supplemental Medi-gap plan to cover those costs.

By law, Medicare Advantage must cover the same benefits as traditional Medicare at a minimum, Foller said. Medicare Advantage plans often add vision, dental and other benefits. The plan Aetna is offering, for example, has provisions for over-the-counter health-related items and post-hospitalization meal delivery.

"Medicare Advantage is the best kept secret," Foller said.

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