Recently, the Medicare Advantage company, Guardian Healthcare, filed for bankruptcy. Because Guardian is, as of 2010, one of the top three Medicare Advantage plans in SC, this filing affects many individuals in the state who have this Guardian Medicare Advantage plan, as well as providers and agents who are owed money by the company.
Regarding the Guardian Healthcare members, the most important thing to note is that the Centers for Medicare and Medicaid Services (CMS) has declared a special election period for many affected members of this health plan in most counties in the state. For those people who have been granted this “SEP”, they will be (or have recently been), notified by a letter from Medicare. Make sure you hold on to this letter. This “SEP” allows those who have Guardian Healthcare’s plan the opportunity to chose either an actual Medicare Supplement plan (also called Medigap) or another plan.
Although health care reform and other changes have greatly affected the number and quality of Advantage plans that are available, there are still a few Medicare Advantage plan options in the state (3 companies that are operating Advantage plans in the whole state). However, as an independent agency, our recommendation would be to use this one-time special enrollment period to choose a Medigap plan. The advantages of a Medigap plan (vs. an Advantage plan) are listed below:
- First of all, Medicare Supplement plans don’t change each year, like Advantage plans do. The plans are Federally-standardized, so each company offers the same outline of coverage for their plans – the only variation is price and company reputation.
- Secondly, Medigap plans, unlike all Advantage plans (as of 1/1/2011), do NOT have networks. Someone who has a Medigap plan can go to any doctor or hospital nationwide that takes Medicare.
- Lastly, Medicare Supplement plans offer a “Guaranteed Issue” into a Medicare Supplement when you are involuntarily losing your Medicare Advantage plan (i.e. Guardian Healthcare). If you have any pending health issues or history of medications or health problems, you have this one-time opportunity to qualify for a Medicare Supplement without medical underwriting or pre-existing condition restrictions.
Overall, the bankruptcy of Guardian Healthcare has been, and will continue to be, a problem for many affected members, providers, and other affected groups. However, for members, because Medicare has granted this SEP, which allows you to choose a new plan without penalty or underwriting, you can take advantage of this one-time opportunity to either select the more comprehensive coverage of a Medicare Supplement plan or find a new Advantage plan.
To get more information about either, please visit South Carolina Medicare Supplements or call us at 877.506.3378.
About Garrett Ball
