If Medicare’s open enrollment period ends each year on December 7, you may be wondering why beneficiaries continue to switch plans well into the new year.

Many suppliers are surprised to discover that Medicare Advantage Plans (MAPs) host their own open enrollment period between January 1 and March 31. During this separate window, beneficiaries that are unhappy with their new MAP’s network or coverage can switch back to Medicare Fee-For-Service or to another MAP.

Next Episode: Thursday, April 18, 2024

Use Eligibility Checks to Identify Plan Switches Proactively

Proactively checking eligibility before delivery and anniversary billing is the best way to stay ahead of insurance changes. Take advantage of eligibility tools in MAP portals. Should a query return a termination date, use the patient’s Medicare Beneficiary Identifier (MBI) to find information about the new plan in one of the eligibility portals hosted by the DME MACs. Contact the patient to get new coverage information, and obtain any required authorizations before delivery where possible.

Educate Patients on Their Options

Many patients find their new plans do not live up to the promises made by insurance agents and clever marketing. Savvy suppliers will continue to help patients understand how plan networks and coverage criteria impact Medicare benefits, especially those beneficiaries that don’t appreciate how closed networks may require changing doctors and/or medical equipment suppliers.