KHN: When Medicare Advantage Drops Doctors, Some Members Can Switch Plans

Medicare News
After insurers dropped hundreds of providers in 2013, CMS issued rules giving people a “special enrollment period” to change plans or join regular Medicare if there was a “significant” change in their provider network.

After insurers dropped hundreds of providers in 2013, CMS issued rules giving people a “special enrollment period” to change plans or join regular Medicare if there was a “significant” change in their provider network.

Susan Jaffe, for Kaiser Health News, reports: “Medicare Advantage plans sold by private insurers are an alternative to traditional Medicare, but they cover services only from doctors, hospitals and other providers that are in the insurer’s network.

Although providers are allowed to drop out of the plans any time, members can usually change only during the annual sign-up period in the fall. There are exceptions, but until recently losing a provider was not among them. After insurers dropped hundreds of providers in 2013, the Centers for Medicare and Medicaid Services (CMS) issued rules giving people a “special enrollment period” to change plans or join regular Medicare if there was a “significant” change in their provider network. The policy took effect last year and applies only to Medicare Advantage members, not to the plans CMS oversees in the health law’s marketplaces.” (Jaffe, 3/29)

Read entire story here.