What Happens When Insurance Plan Is Discontinued? | News, Sports, Jobs

Question: I just received correspondence from my insurance company informing me of my 2024 insurance is discontinuing and won’t be offered in 2025. What should I do?.

Answer: Happy Insurance Season! It is September 30th and your plan is required to inform you what it is doing for 2025. We have been talking about how 2025 changes to prescription drug coverage will impact insurance offerings and we are seeing some significant changes for 2025. There are more plans than normal not being offered in 2025. There are also significant premiums increases for many products. There are other products that seem to be changing very little. Now what do we do with all that general information?

The answer to your question is “It Depends!”

When your plan has been discontinued you are given additional time to make your insurance decision for 2025. So in addition to the normal Annual Enrollment Period, October 15th to December 7, you will have until December 31 to enroll into a plan for January 1st with no gap in coverage. You also have the additional months of January and February to enroll in a new plan, but during these months you will have a gap in coverage of at least a month or up to two months. During these months you have ONLY original Medicare NO drug coverage, because your plan WILL TERMINATE as of January 1.

I have started to hear from a number of people who have received their Annual Notice of Change (ANOC) from their insurance company. This letter is a required notification they must send to every individual to describe the insurance coverage in the New Year (2025). Medicare Part D Prescription Drug Plans (PDP’s) and Medicare Advantage Plans (MA) are required to deliver that ANOC letter to you before 9-30-24. Some insurance companies mail them out weeks before that. Some insurance companies stick right to that 9-30-24 required date.

In a situation like yours, the plan you have is not being offered in 2025, so you didn’t get an ANOC because there won’t be coverage offered to you for 2025. Your notification informs you of that discontinued plan and advises you to look into alternative coverage by the end of the year.

For those individuals whose plan is still offered, the ANOC packet includes information regarding current coverage (2024) and then next year’s coverage (2025). Usually the most important information is on the first or second page of the booklet/packet.

When these packets arrive, I begin to hear from clients letting me know what they say and asking questions about what to do.

One of the biggest changes overall this year is the change in Prescription Drug Coverage. In 2025 there is no Coverage Gap (Donut Hole). Many of the plans have a deductible which can be no more than $590. After meeting this deductible, you enter the Initial Coverage phase where your medications are divided into tiers, and you pay the copay based on the tier of your medication. In 2025 as you pay copays, they accumulate towards the maximum out of pocket which is $2000. Once you have paid that $2000 amount your copay move to $0 for all covered medication for the remainder of the year.

Remember that each Insurance Plan classifies medications into ‘Third Party’. The medications you take may be the same, but the Tier they are assigned to can change year to year. This will affect her price you pay for the medication, usually the higher to Tier, the higher the copay. So review the ANOC packet to see if the medications you take have changed.

If you have a Medicare Advantage Plan your insurance will still mail you an ANOC, but it will include much more information. It will cover the monthly premium for the plan, the Part D prescription drug benefit AND the Health Insurance co-pay structures. So there are a lot more changes that can be made to the plan.

Your Medicare Advantage Plan may still have a similar monthly premium, but the amount you pay at providers and for medical procedures can change. The Prescription Drug Benefit will also change.

It is important for you to begin researching your alternatives. If you plan has been terminated any plan you enroll into from October 1 to December 31 will begin January 1 as I mentioned before. Take the extra time to evaluate your options. Meet with someone who understands the options and evaluates your needs fully.

Now you see why I get so excited about the October 1st information! There is so much new and exciting information to review!

For those of you that received the ANOC letter and packet of information you have a lot of useful information you should review. After reviewing the changes to your plan, you can make your decision to keep your plan or make a switch. If you want to change your insurance, you have that October 15th to December 7th timeframe to make that change. If you decide to keep the plan you currently have you don’t have to do anything, it will just continue to cover you in the 2025 calendar year.

Happy Insurance Season!! It’s finally here!

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email [email protected].