Switched Medicare Plans During Open Enrollment in North Carolina? Who Pays Old Medical Bills

Switching Medicare plans in North Carolina? Your old plan pays for care you got before your new plan starts. Learn what to watch out for and how to avoid billing mistakes.

In this episode

• Learn which Medicare plan pays for care before your new coverage starts
• Find out what to do if your provider bills the wrong plan after switching
• Get tips on avoiding common mistakes with old and new Medicare claims

Source: Open Enrollment (medicare.gov)

Billy Jordan is a licensed insurance agent (NPN 8699876) with The Jordan Insurance Agency, based in Charlotte, North Carolina. Voices in this episode are AI-generated, including Billy's, from a script reviewed and approved by Billy Jordan, a licensed insurance agent. General education only, not advice for your specific situation.

Not affiliated with or endorsed by Medicare or any government agency.

Tanya (AI host): If I switch Medicare plans during Open Enrollment, who actually pays an old claim for a doctor visit I had before I switched? Stick around, because a lot of people here in North Carolina get confused about this one.

Tanya (AI host): Welcome to Smart Coverage. Real Advice., the insurance podcast from The Jordan Insurance Agency. I'm Tanya, your host, and I'm here with Billy Jordan, a licensed insurance agent and the president of The Jordan Insurance Agency.

Billy Jordan: Glad to be here, Tanya. A quick disclaimer: we're not affiliated with or endorsed by Medicare or any government agency, and this is general education, not advice for your situation. Now, let's get into it.

Tanya (AI host): So, let’s say someone in North Carolina changes their Medicare plan during Open Enrollment. They go to the doctor in November, but their new plan doesn’t start until January. Who’s supposed to handle that doctor’s bill?

Billy Jordan: That’s a great question, and it comes up a lot. According to medicare.gov, when you switch Medicare plans during Open Enrollment, any care you got before your new plan starts is billed to your old plan, the one you had at the time of the appointment. Your new plan is only responsible for services you get after your coverage with them actually begins, which is usually January first.

Tanya (AI host): So, if I saw my doctor in November and my new plan starts January first, my old plan should still pay that November visit?

Billy Jordan: Exactly. The date you received the care is what matters—not when the bill is sent or when you switch plans. For example, if you had a blood test on November twentieth, your old Medicare plan is responsible for processing and paying that claim, even if you get the bill in January after your new plan starts.

Tanya (AI host): That makes sense, but I bet there’s a catch somewhere. What’s a common mistake people make here?

Billy Jordan: A big mistake is people thinking their new plan will pay for services they got before their start date. That’s not how it works. Another issue is people sometimes throw away paperwork from their old plan, thinking they won’t need it anymore. But if a claim from November gets processed in January, you might need to talk to your old plan or show proof of coverage.

Tanya (AI host): What if the doctor’s office sends the bill to my new plan by accident?

Billy Jordan: That can happen, and it can delay payment. If your provider sends a claim for care you had in November to your new plan, the new plan will usually deny it, because you weren’t a member yet. At that point, you or your doctor’s billing office need to resubmit the claim to your old plan—the one you had when you got the care.

Tanya (AI host): So, for folks in North Carolina, does this process work the same way, or are there any local quirks to be aware of?

Billy Jordan: In general, this rule is the same in North Carolina as it is nationwide, according to medicare.gov. Your old Medicare plan handles claims for services you got before your new plan starts. The only thing to watch out for is making sure your providers have your correct insurance information for the dates you saw them, especially if you’re switching between different types of Medicare plans.

Tanya (AI host): Does this apply whether I’m switching from Original Medicare to a Medicare Advantage plan, or the other way around?

Billy Jordan: Yes, it applies both ways. If you move from Original Medicare to a Medicare Advantage plan, or from a Medicare Advantage plan back to Original Medicare, the plan you had on the date of service handles the claim. For example, if you were on a Medicare Advantage plan in November and switch to Original Medicare in January, the November claim goes to the Advantage plan.

Tanya (AI host): What about prescription drugs? If I switch drug plans, does the same rule apply?

Billy Jordan: Yes, it does. If you fill a prescription in December under your old drug plan, that plan is responsible, even if your new drug plan starts in January. The key is always the date you got the medication or service.

Tanya (AI host): Is there anything else to watch out for during this transition?

Billy Jordan: One thing is to keep all your plan cards and paperwork until you’re sure all your claims have been processed. Sometimes, claims for services you got in November or December don’t show up until after your new plan starts. If you’ve tossed your old card or info, it can make sorting out those claims harder. And always check your Explanation of Benefits from your old plan to make sure services you got before January are paid correctly.

Tanya (AI host): Three things to remember. One, your old Medicare plan pays for services you got before your new plan starts. Two, always check the date you received care—not when the bill arrives. Three, hang onto your old plan info until all your old claims are processed.

Tanya (AI host): For a personalized look at your situation, book a free thirty-minute chat with Billy and his team at thejordaninsuranceagency.com/podcast.

Billy Jordan: I'm Billy Jordan with The Jordan Insurance Agency. Until next time, take care.

Tanya (AI host): Thanks for listening to Smart Coverage. Real Advice. from The Jordan Insurance Agency.