Throughout the country, HCFA contracts with managed care plans to provide Medicare benefits. Managed care plans are independent businesses which voluntarily enter into annual contracts with the Health Care Financing Administration to provide services to Medicare beneficiaries. HCFA pays the contracting plans a monthly amount for each enrolled Medicare member in exchange for providing all Medicare covered services to these members.
Medicare managed care contracts are for a calendar year. Each year, as a matter of doing business, plans review their options and make a choice of whether or not to continue their contract, adjust premiums and/or benefits, extend their service areas or not renew the contract. A decision not to participate is called a nonrenewal. Nonrenewal decisions can apply to an entire plan contract or only to selected counties served by that plan.
HCFA is responsible for assuring that contracting managed care plans meet their contractual obligations. However, HCFA has no control over the plans annual business decisions, nor can HCFA force plans to renew their contracts.
For calendar 1999, some managed care plans have decided not to renew their contracts to provide services to Medicare beneficiaries in certain states and selected counties.
If you are a member of a plan that has chosen not to contract to provide Medicare benefits in calendar 1999, the plan will send you a notification no later than November 2, 1998. You will need to decide how you want to receive your Medicare services after December 31, 1998.
- You may be able to join another Medicare managed care plan similar to the one in which you are currently enrolled; OR
- You can return to the Original Medicare Plan.
Either way, you are still in the Medicare program and will receive all the Medicare covered services.
Changing the way you receive your health care is an important decision. You may wish to ask your family, friends, or doctor for help. Special rules may apply when you disenroll from a Medicare health plan and return to the Original Medicare Plan with a supplemental insurance policy (Medigap). If you or your spouse have health care coverage through a former employer or union, contact your benefits representative before you make a new health plan choice. If you have Medicaid coverage, do not make a new health plan choice until you contact the State Medical Assistance Office.
Joining Another Medicare Managed Care Plan
You may wish to join another Medicare managed care plan. Beginning January 1, 1999, new rules will in most cases allow you to be enrolled in this kind of plan only if you are entitled to Medicare Parts A and B and do not have permanent kidney failure (ESRD). If you choose to enroll in another Medicare managed care organization before December 31, 1998, you will automatically be disenrolled from the current plan.
If you require information before November 2, or need further assistance, call your State Health Insurance Assistance Program (SHIP). The phone number for the SHIP in your state is available at http://www.medicare.gov/contacts.
Plans that contract with HCFA to provide services to Medicare beneficiaries during calendar 1999 are required to accept your enrollment in November 1998, to be effective January 1, 1999. Call these plans with your questions about premiums, benefits, their enrollment process, and effective dates of coverage.
Please note that some of these Medicare managed care organizations may also accept your enrollment during the month of December. Be sure to enroll no later than December 31, 1998 for your coverage to begin January 1, 1999.
Returning to the Original Medicare Plan
You can return to the Original Medicare Plan in one of two ways:
1.) Remain enrolled in your current plan until December 31, 1998, and you will be automatically returned to the Original Medicare Plan starting January 1, 1999; OR
2.) Return to the Original Medicare Plan before December 31, 1998, by:
a.) Submitting a written request to disenroll to your current plan or
b.) Contacting your local Social Security Office, or Railroad Retirement Office (if you are retired from the railroad) and ask for disenrollment information. You will be disenrolled effective the first day of the month following the month you requested disenrollment. For example, if you request disenrollment on November 20th, you will be returned to the Original Medicare Program effective December 1, 1998.
If you do choose to disenroll before December 31, you should understand that until your disenrollment from your current plan is effective, you must continue to follow plan rules for receiving your health care services.
Caution: If you disenroll before December 31, 1998, you may not be guaranteed certain Medigap protections. Whether you disenroll before December 31, 1998 or allow your enrollment to be automatically terminated on that date affects your rights to Medigap coverage under the law.
ADDITIONAL ASSISTANCE
Your State Health Insurance Assistance Program is available to assist you in understanding this information and in making any important decisions. The number for the SHIP in your state can be found at http://www.mediare.gov/contacts.html.
Starting November 2, 1998, up-to-date information about plans available during 1999 can be found at Medicare Compare located in the Medicare Health Plans section. After November 2, 1998, you can request information on Medicare+Choice health plans available in your area by using the automated Medicare Special Information number (1-800-318-2596 or TTY at 1-877-486-2048).