Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement surgery. As a result, he has spent the last three months in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What advice would you give him regarding his health coverage options?

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Question:

Mr. Roberts is enrolled in an MA plan. He recently suffered complications following hip replacement surgery. As a result, he has spent the last three months in Resthaven, a skilled nursing facility. Mr. Roberts is about to be discharged. What advice would you give him regarding his health coverage options?

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Answer:

Mr. Roberts’ Open Enrollment Period for institutionalized individuals will remain for two more months after he is discharged from the Resthaven skilled nursing facility.

Explanation:

According to the Medicare Advantage Plans, a person can avail Open Enrollment Period for institutionalized individuals (OEPI).  

An individual, who moves to an institutional medical care unit, resides and moves out of the institution once his/her medical condition has improved. He/she can still avail the OEPI for two more months from the date of discharge from the institution.  

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There are also options according to the criteria met under the Special Enrollment Period for institutionalized individuals.

Mr. Roberts can either switch back to his original medicare plan or avail the two months period of OEPI.

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