Medicare Open Enrollment is underway, bringing important decisions for Medicare-eligible patients and potential changes for your agency. With the enrollment period running from October 15 through December 7, agencies need to stay informed about changes to Medicare Advantage plans, how those changes may affect patient coverage, and what steps they can take to prepare.
Open Enrollment provides an opportunity for patients with traditional Medicare to switch to a Medicare Advantage plan. It also allows patients who are currently enrolled in a Medicare Advantage plan to switch to a different Medicare Advantage plan if they choose.
One important issue that your agency needs to be aware of is the significant changes being seen in Medicare Advantage plan coverage areas this year. Some Medicare Advantage plans are withdrawing from certain service areas, while others are entering new markets. In some cases, plans are leaving specific coverage areas without expanding into other areas, making it especially important to stay informed about which plans will be available to your patients.
If a Medicare Advantage plan withdraws from your coverage area and you currently have patients enrolled in that plan, those patients may experience changes to their coverage, potentially without fully realizing what has happened.
It’s important to have conversations with your patients about notifying your agency whenever they make changes to their insurance coverage or receive information indicating that their coverage may be changing. Encourage patients to share any new insurance cards they receive in the mail, along with letters, notices, or other communications related to their coverage. Staying informed about these changes is essential to ensuring your agency has accurate insurance information for each patient.
It’s also important to evaluate your agency’s existing contracts with Medicare Advantage plans. Are there contracts that need to be renegotiated? Do you currently have agreements with plans that are withdrawing from your service area? Are you aware of new Medicare Advantage plans entering your market, and have you identified opportunities to negotiate contracts with those plans?
With so many changes taking place, agencies need to look beyond whether their patients are switching plans. It’s equally important to assess how these changes may affect existing payer relationships and determine whether your agency needs to take action through the contracting and credentialing process.
In addition, the first quarter of the year brings another enrollment opportunity for patients who are currently enrolled in a Medicare Advantage plan. Even if they selected a new plan during the fall Open Enrollment Period, they have one opportunity in the first quarter of the year to make another change to their Medicare Advantage coverage.
Throughout the year, patients may also have an opportunity to switch from their current Medicare Advantage plan to a five-star-rated Medicare Advantage plan. This option is available even if they are already enrolled in a five-star-rated plan and wish to move to another, provided they meet the eligibility requirements.
It’s important for agencies to verify patient eligibility at least weekly during the first quarter of the year. After the first quarter, it is strongly recommended to continue these verifications at least once a month to confirm that your Medicare patients remain eligible and that their coverage has not changed.
For agencies operating in areas with a high concentration of Medicare Advantage plans, particularly those that have experienced frequent changes in patient coverage, more frequent eligibility verifications may be necessary.
Regina Wild, HPS Director of Managed Care Consulting, will be hosting an HPS FREE Webinar on November 5, “Medicare Post-Open Enrollment Essentials: Best Practices for Home Health Agencies”. This webinar will focus on Medicare Open Enrollment and navigating changes with Medicare Advantage plans. This is a valuable opportunity to learn more about these important topics, and you won’t want to miss it!
If Healthcare Provider Solutions can assist your agency with Medicare Advantage billing or contract negotiations, please don’t hesitate to reach out to HPS.
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