If your client decides to change Medicare Advantage (MA) plans during the year, one important question is: Will the out-of-Every year during the busy Annual Election Period (AEP), it’s important to know which clients need immediate help to avoid gaps in coverage—especially those whose Medicare Advantage (MA) plans are ending.
What Happens If a Client’s MA Plan Ends?
If a client’s Medicare Advantage plan is ending this year, they have a Special Enrollment Period (SEP) that lasts until February 28th to select a new Medicare plan. Here’s what you need to know:
- If the client does not choose a new plan by December 31st, they will be automatically enrolled in Original Medicare starting January 1st.
- Clients also have a Guaranteed Issue (GI) right to enroll in a Medicare Supplement (Medigap) plan, which will begin the month after they apply.
Why Do Medicare Advantage Plans End?
Several factors can cause an MA plan to end, including:
- Plan Withdrawal: The insurance company stops offering the plan due to financial reasons or restructuring.
- Service Area Changes: The plan is no longer available in the client’s area because the insurer has reduced its service region.
- Contract Termination: Medicare ends its contract with the plan if it doesn’t meet CMS standards or requirements.
- Non-Renewal: Medicare decides not to renew the plan’s contract for the upcoming year.
- Low Performance: Plans with consistently poor ratings from the Centers for Medicare & Medicaid Services (CMS) may be discontinued.
- Provider Network Changes: Healthcare providers or hospitals may end contracts with the plan due to administrative or payment issues.
What Should Clients Do?
Clients in this situation need to act quickly to maintain continuous coverage into the next year. Make sure to prioritize helping clients whose plans are ending before December 7th, so they can:
- Choose a new Medicare Advantage or Part D plan during AEP, or
- Understand their options to enroll in Original Medicare or a Medicare Supplement plan during the SEP.
By staying on top of these changes, you can ensure your clients don’t experience gaps in their healthcare coverage and get the support they need to navigate their Medicare options.
Contact National Insurance Markets for more information.
