Medicare Open Enrollment Tips for HME Providers

The Medicare open enrollment period began on October 15, 2016 and runs through December 7, 2016.  It’s important to know how these plan changes will impact your patients and your company.  Even though the enrollment period runs through December 7, it may take longer for many plans to update their systems.

Determining Plans Available in your Service Area

Many insurance plans may add products or eliminate products they previously offered.  There may even be new insurance plans created and offered in your areas.

This is the website that beneficiaries can use to investigate plan choices.

        https://www.medicare.gov/find-a-plan/questions/home.aspx

Providers can enter the zip code for their service area to determine which plans are available to their patients and answer the following questions.

1.     How do you get your Medicare coverage?
        -- Select “Original Medicare”

2.    Do you get help from Medicare or your state to pay your Medicare prescription drug costs?
       -- Select “I don’t know”

3.    Select "I don’t want to add drugs now"

You can then Select “All” and “Continue to Plan Results” to obtain listing of all the plans in your service areas.  This will also give you deductible and copays for durable medical equipment for each plan. 

Next Steps After you have the Plans Available

Review these plans and determine your risk as a company in plans that you are not in network with.  Determine if these plans offer out of network benefits.

Develop a plan to ensure you have current insurance information on all new and existing rental patients.  Develop transition plan for those patients electing a payer you are not in network with if they do not offer out of network benefits.

You can elect to send letters to all your existing rental patients informing them of open enrollment and steps they should take in informing you of insurance changes.  You can suggest in this letter the plans that you are in network with as plans they may want to choose.

Evaluate if there are any big budget changes based on plans available.

Plan changes could have an impact on your revenue stream.  Preparing for these can help eliminate denials and rework in your companies.