Caregiver’s Guide to Assisting With Open Enrollment

Caregiver’s Guide to Assisting With Open Enrollment

 

 

 

It’s that time of year! From October 15 until December 7, Medicare beneficiaries will be able to change their choices for Part D (prescription drug) coverage, enroll in or change a Medicare Advantage plan, and (in certain circumstances) possibly change Medigap plans.

 

Just writing that sentence can give one a knot in the stomach. Too many choices, not enough information. Where should you begin?

The Medicare Open Enrollment Period is an annual period of time (October 15 through December 7) when current Medicare users can choose to re-evaluate part of their Medicare coverage (their Medicare Advantage and/or Part D plan) and compare it against all the other plans on the market. After re-evaluating, if you find a plan that is a better fit for your needs, you can then switch to, drop or add a Medicare Advantage or Part D plan. Medicare Advantage is also known as a “Part C” plan.

Medicare Advantage plans are private health plans that have contracts with Medicare. When you join one, you get your Medicare-covered healthcare services through the private plan.

 

 

 

 

If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgently needed care.

The plan can choose not to cover the costs of services that aren’t medically necessary under Medicare. If you’re not sure whether a service is covered, check with your provider before you get the service.

Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.

 

First, your care recipient should have received an annual notice from the companies that are supplying their coverage.

Some of the packages look overwhelming and one just longs to discard them. But wait. At least take out the thinner booklet–the Annual Notice of Change (ANOC)–and look at the first few pages.

 Some of the packages look overwhelming and one just longs to discard them. But wait. At least take out the thinner booklet–the Annual Notice of Change (ANOC)–and look at the first few pages.

Is the plan premium going up? If so, is it going up a LOT? If the increase is 10% or higher, that indicates that there may be a better alternative out there.

What about the deductible? If it used to be zero, and now it’s not, that’s another indication that you may want to think about changes. The more difficult information to assess is changes in the drug premiums.

When you opened your packet, you saw the company had added another “tier” to the generic drugs. Your care recipient takes generic drugs. How will this affect them?

 

 

 

Is your loved one in a Part C/Medicare Advantage/ Managed Care plan? Do you have any idea what you paid out in copays this year? Were there unexpected expenses that the plan did NOT pay? Are they likely to recur? You may want to consider changing to a Medigap plan with fixed costs.

 

Conversely, are you paying for a Medigap plan, but your loved one has few, if any, physician visits, except annual wellness checks and preventive benefits? If your relative lives in the same area year-round, you may want to investigate Medicare Advantage plans with lower premiums and possible additional benefits like hearing and vision assistance.

It is wise to assess these things each and every year. But if you haven’t reassessed in at least three years, you need to think about having a “checkup.” A number of options exist:

 

  • Access free professional advice about Open Enrollment from a licensed benefits advisor.

 

  • Find a State Health Assistance Insurance Program (SHIP) counselor in your region. SHIP provides free, federally funded one-on-one Medicare counseling. You can visit the SHIP website or call their toll-free number at 1-877-839-2675. However, be forewarned—it is often difficult to access this program during the Open Enrollment period. This is a particularly busy time of year for SHIP so be patient with the office and be sure to call as early as October 1 for an appointment. You can also call your local “Area Agency on Aging” and ask if they are hosting any public information sessions about Open Enrollment that you can attend. This will provide you with a helpful intro to the topic, and you may even be able to ask questions publicly and privately.

 

 

SHIP volunteers and staff provide free, objective information and assistance to people with Medicare and their families, by telephone and sometimes in face-to-face sessions.

 

Your SHIP can help you:

 

  • decide when and how to get your Medicare coverage
  • compare various options for receiving your Medicare benefits
  • review situations involving both Medicare and your state’s Medicaid program
  • decide if you need additional coverage or different coverage
  • determine if you already have other health benefits in addition to or instead of Medicare
  • compare various ways for you to supplement your Medicare benefits and, in some states, help you compare benefits and costs of specific plans

 

You can also call  1-800-MEDICARE (1-800-633-4227), the Medicare program’s toll-free number. You may have to wait. Try to call during “off hours.” Once you get an advisor, make sure that they tell you what your loved one’s “saved drug ID” and “password date” are so that you can use this information to do your own research on whether their drug formulary has changed.

 

*In most cases, you won’t have a right under Federal law to switch Medigap policies unless you’re eligible under a specific circumstance or guaranteed issue rights or you’re within your 6-month Medigap Open Enrollment period.

By law, when you buy a Medigap policy, you have a 30-day “free look” or trial period. If you change your mind within 30 days of the day your policy started, you can cancel it and get a refund.

If you are switching Medigap plans, do not cancel your first policy until after your free look period is up. You may have to pay two premiums for 1 month. But you will be able to change back to your first plan if you need to.

Your state may, however, have expanded these rights.  Consult your state health insurance department to learn the rules in your area.

 

Recommended: Medicare for Dummies, 2nd Edition

In plain language, the new edition explains:

  • How to qualify for Medicare, according to your personal circumstances, including new information on the rights of people in same-sex marriages
  • When to sign up at the time that’s right for you, to avoid lifelong late penalties
  • How to weigh Medicare’s many options so you can be confident of making the decision that’s best for you
  • What Medicare covers and what you pay, with up-to-date details of the costs of premiums, deductibles, and copays—and how you may be able to reduce those expenses

 

 

Thanks for visiting and reading … I hope this article provided you some helpful ideas.  I welcome your comments below.

-Laurie

 

 

 

 

 

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