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Monday, May 2, 2016

It is now Medicare open enrollment

Wednesday, October 24, 2012

Since it is now the Medicare open enrollment period, it is appropriate to talk about this special period that occurs once a year. Open enrollment started on Oct. 15 and will end on Dec. 7.

Much of what I am writing about is a repeat from last year.

During this special period, those on Medicare may enroll into a Medicare Advantage or into a Prescription Drug Program. It is also a time when those previously enrolled may enroll in different plan. The effective date for the changes will be Jan. 1, 2013.

People receiving Medicare are referred to as beneficiaries. Most think of a beneficiary as someone who is going to receive benefits from life insurance. Still, those of us receiving Medicare are considered to be Medicare beneficiaries. That means that if you are on Medicare, you are a beneficiary.

More people are enrolled in a Medicare Advantage plan than in a Medicare supplement. With the Medicare supplement premiums increasing in price, many beneficiaries are changing over to a Medicare Advantage plan where there are zero premiums or low premiums. One of the ways you may consider the difference in a supplement and a Medicare Advantage plan is that you pay in advance for the supplement and you pay for the Medicare Advantage plan as you use it.

With Medicare Advantage plans there is a set maximum of out of pocket cost for the year. Even though the beneficiary has a large health care bill for the year, the beneficiary only pays out the maximum amount. The total amount, the premiums and co-pays vary from one plan to another. When considering enrolling, all of these things need to be taken in consideration, or if you are enrolled at the present time, you need to compare with other plans.

A difference in Medicare Advantage and supplements is that the Medicare Advantage Plan is a contract for one year, compared to a Medicare supplement which is for life, as long as the premiums are paid. This year, because Medicare funds are being reduced, a large number of beneficiaries have lost their Medicare Advantage Plan causing them to lose their coverage, so they need to go to another plan, either Medicare Advantage, a supplement or original Medicare.

Also, because of funds being taken out of Medicare, companies are reducing some of the additional benefits such as physical fitness programs. Many are also raising their rates and /or their co-pays.

If you have a supplement, it can be used with any provider in the nation that will take Medicare. There are getting to be more doctors in some areas that won't take Medicare. That would make it difficult for most Medicare beneficiaries. This trend will most likely increase, although I hope not. Still, there is an indication that there will be a shortage of doctors.

There are doctors in our area who do not take some of the Medicare Advantage Plans. If you are considering enrolling in a plan, it will be to your advantage to check to see if your physician is in the network or to check to see if they are taking the plan. Once you are enrolled and if you find they do not accept the plan, you may have to go to another provider. There is a period when you can disenroll from a Medicare Advantage Plan and go back to original Medicare.

One thing that must be said is that if you are satisfied with your plan, including your Part D, you do not need to change plans. You can be in a position to entirely ignore the Medicare open enrollment. Your plan will continue, unless you have been notified by the company that it isn't.

The prescription drug program may be included in a Medicare Advantage Plan or it can be a stand alone Part D. There is help for many people to assist with the cost of prescriptions. There are many that qualify for help and do not realize it. Those on Low Income Subsidy with Social Security need to apply for renewal each year. It will depend on the level of Low Income Subsidy for the amount of assistance received. Those on full LIS will have their Medicare Part B premiums paid, as well as their Part D Plan premiums and have a low co-pay for prescriptions. Many people can also get help from the Missouri Prescription Plan. Many can get help with prescriptions even if they do not qualifying for the low income subsidy. You must have a Plan D to receive help with the Missouri Drug Plan.

Those who qualify for extra help and join a Prescription Drug Plan will get help in paying for the drug plan's monthly premium, yearly deductible, coinsurance and co-payments. There is no coverage gap and no late enrollment penalty. Everyone is urged to check with Social Security to see if they might qualify.

Insurance agents marketing Medicare Advantage and PDP plans have to meet certain qualification and become certified to market the products. There are a lot of things they cannot do, such as providing meals or going door to door.

There are agencies and people helping seniors to enroll during the open enrollment period, but most of these individuals are not certified.

Most of us on Medicare have received "Medicare and You" from Centers for Medicare and Medicaid Services (I have not received a copy). This is a great source of information about Medicare. Many on Medicare refer to this publication for information. Another good and official place for Medicare information is www.medicare.gov.

Leonard Ernsbarger
Leonard At Large