The period for Open Enrollment in Medicare runs from October 15 to December 7. Throughout this period, any patient qualifying for Medicare has the opportunity to alter their existing coverage. They have the choice to switch from one Medicare Advantage plan to another, revert from a Medicare Advantage Plan to traditional Medicare, or transition from traditional Medicare to a Medicare Advantage plan. It’s vitally important that your agency engage in conversations with your patients during this phase, ensuring that any decisions they make are relayed to you as their health care provider.
It’s crucial that they comprehend the impact of any alterations they might consider. If they seek your advice on choosing between different plans, it’s perfectly acceptable for you to engage in that discussion. As a field staff member, you may not have all the required information at your fingertips, but there’s likely someone within your organization who can answer their questions.
This is a critical period as the changes made during this Open Enrollment phase will be implemented starting January 1. It’s essential for you to regularly verify Medicare eligibility of every patient of Medicare-eligible age at least once a week in January to account for any changes. This includes any patient currently under your care as we near January 1. This is specific to home health and hospice services. Hospice is not exempt from this. In cases where the Value-Based Insurance Design model, or VBID model, is in effect, hospice now also has to deal with Medicare Advantage.
Be aware that there have been modifications to the VBID model concerning the participants for Hospice in 2024. A noteworthy change is the withdrawal of United Healthcare from the VBID model participation for 2024, which involved more than 25 Medicare Advantage plan packages. Therefore, hospices that currently have patients enrolled in United Healthcare within the VBID model will continue to participate in VBID and bill United Healthcare if those patients are still under your care in January. However, once a patient passes away, revokes the benefit, or is discharged live for any reason, any new admission would revert back to traditional Medicare. Yet, as long as they stay under your care from January 1 forward, and if they were already part of a VBID participating plan – be it United Healthcare or any other plan that has withdrawn – you will continue to bill that plan until the patient revokes the benefit, is live discharged, or unfortunately passes away.
It is important that both your field and administrative staff, who can discuss this significant period with patients, are prepared to answer any questions and collect information about any changes the patients might undertake. They need to understand if patients switch to a Medicare Advantage plan, you will be obliged to bill that Medicare Advantage plan from January 1 forward.
Please ensure you stay updated and that your staff grasps the implications of appropriately responding to your patients’ inquiries about Open Enrollment.
If there’s any way Healthcare Provider Solutions can assist you in maneuvering through the Open Enrollment period, please feel free to reach out to us.
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