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This is an audio broadcast prepared by California Health Advocates entitled “Medicare: Fall Enrollment.” In this broadcast, we will briefly describe the annual election period and provide advice about what people should review when considering whether to make a change in their Medicare coverage.
Every year from November 15 – December 31, people with Medicare are allowed to make changes to the way they get their health insurance in the following year. People who are in a Medicare Advantage plan can switch to a new plan or choose to disenroll and return to Original fee-for-service Medicare. Similarly, those who are in Original Medicare and want to enroll in an MA plan can do so during this annual election period.
In addition, people can switch Part D drug plans or enroll in a Part D plan if they have not already done so.
Many Medicare plans (both MA plans and Part D plans) change their coverage and the amounts people have to pay out of pocket every year. If you are enrolled in a plan, your plan must send you a summary of their changes in costs and benefits for the new year by October 31st. It is important to review these changes. Even if your plan has provided good coverage for you this year, their benefits for the New Year may be quite different.
Researching and knowing your options are important. The Health Insurance Counseling and Advocacy Program offers free, unbiased counseling on these options and your rights as a Medicare beneficiary. We’ll give you their phone number at the end of this broadcast.
When Can I Change Plans?
As mentioned, each fall the Annual Coordinated Election Period (AEP) is from November 15th through December 31st of each year. During this time, you can make a change in your health coverage for the following year with the change becoming effective on January 1st. So, for 2008, you have until December 31st, 2008 to choose a plan for 2009.
The AEP is the main time to make any plan changes. There are some exceptions.
For example, Medicare Advantage plans have an Open Enrollment Period (OEP) between January 1 and March 31 of each year. During this time, you are allowed to make one change for certain plans (for instance, you can get in and out of Medicare Advantage plans, but can’t go from a stand alone Prescription Drug Plan - PDP to another PDP).
Another exception is that when particular events happen that impact your health coverage, you may be entitled to a Special Enrollment Period. Information on such special enrollment periods can be found on our “Medicare Enrollment Periods” fact sheet on our website at www.cahealthadvocates.org.
Also, people with Medicare and Medi-Cal are allowed to switch plans any month.
What Are My Options During Fall Enrollment?
If you are already in Original Medicare and want to stay in Original Medicare, you can just look at the upcoming changes in your Part D plan. If you decide you want to switch to a different plan, or enroll in one if you haven’t enrolled in Part D already, you must do so during the Annual Election Period (November 15 – December 31) with the change of your plan effective January 1, 2009.
The same is true if you are in an MA plan and want to leave it and return to Original fee-for-service Medicare. You must disenroll from your plan between November 15 – December 31st for an effective disenrollment of January 1. Also, if your MA plan is an MA-PD plan (meaning it also offered Part D prescription drug coverage), you’ll want to enroll in a new Part D plan during the annual election period. This way your new Part D plan will be effective January 1st, the same time your current coverage ends.
Note: If you are returning to Original Medicare and want Part D coverage, you must choose a stand-alone PDP.
Remember, when you are in Original Medicare, you can also have certain other coverage, like a Medicare Supplemental Insurance policy (Medigap), or a retiree plan to supplement your Medicare. If you are returning to Original Medicare from being in an MA plan, make sure to coordinate the start of your supplement insurance for the 1st of the New Year to prevent any gaps in coverage.
If you want to enroll in a Medicare Advantage health plan or switch to a different MA plan, you must do so between November 15 – December 31. Make sure you compare your options.
Also, understand that when in an MA plan, you generally must get all of your Medicare services through that plan, including your prescription drug coverage (Part D). If the MA plan you choose is an MA-only plan, meaning it does not have Part D prescription drug coverage, you will have to also enroll in a separate stand-alone PDP during this annual election period.
How Should I Decide What To Do?
If you are in an MA plan and/or a PDP, look at your current coverage and compare it to what your coverage will look like next year. Even if you stay in the same plan (PDP or Medicare Advantage), it will likely change some of its benefits and costs for the New Year.
Make sure you understand how your plan works.
- Know what’s covered and what’s not.
- Remember, the plan must notify you of any benefit and cost changes for the coming year by October 31st. Also, in regards to your Part D coverage, they must notify you if they plan to drop or change the cost for a drug you are currently taking.
Review your notices of next year’s coverage and find out the following:
- What your cost sharing is. For your Part D coverage, make sure to find out how your cost sharing changes if you use a different pharmacy or when you travel. Again, these amounts may be different in your plan’s benefits for next year.
- What the rules are for:
- Getting prior approval for your prescriptions or certain health care treatments;
- Asking for an appeal or exception, for example, if your drug isn’t covered; and
- Filing appeals, for example, if your drug is dropped or your exception request is denied.
For Your Part D Coverange, Inventory Your Prescriptions
This will help you compare your current plan with the plans available and choose a plan the best meets your needs.
For your drug inventory, make a list of the drugs you take.
- Know the names of those drugs and know if your drugs are brand name or generic drugs.
- Know the quantities you take.
- How many pills or units do you get?
- 30 day, 60 day, or 90 day supply?
- Know the pharmacies in your area.
- Which pharmacies are you willing to use?
- Which pharmacies are closest to your house?
- Which pharmacies are in the plan’s network?
- Will any of them deliver to your home?
- Can you use mail order service, and if so, does it cost less?
Compare Other Plans
Once you have your drug inventory, take the information you have about your current plan, and how it will change next year, and compare it other plans out there. Do the same thing with your other MA plan benefits if you are in a Medicare Advantage plan.
Remember:
- Every plan is different. In terms of Part D coverage and comparing Part D plans, each plan has its own different list of covered drugs (or formulary). Review these lists to make sure your drugs are on them. Some drugs you take may not be covered.
- MA and PDP plans have different cost sharing and premiums.
- Some plans have deductibles, others have none.
- Co-payments can vary within the same plan.
- For Part D, there may be a gap in coverage during which you pay 100% of the costs.
- MA and PDP plans have different networks of doctors, health care facilities and pharmacies. Make sure your doctors and pharmacies are in those networks.
- For Part D, different plans may have different rules. For example:
- You may require your plan’s permission to take the drug your doctor prescribes (called prior authorization);
- You may have to try a more common drug first before your plan will cover the drug your doctor prescribes (called step therapy); and
- Your plan may have limits on the amounts, or length of time you can take a drug (called quantity limits).
IN SHORT, IT PAYS TO DO YOUR HOMEWORK. You may decide that you don’t want to make any changes to your Medicare coverage, but it is worth the time learning about your current coverage as well as what other plans are being offered for 2009.
Where to get more help and information
If you would like to talk to someone to learn more about your options under Medicare and related health coverage issues, you can get free individual counseling by calling the Health Insurance Counseling and Advocacy Program (HICAP), with offices in every county in California and a toll-free hotline. HICAP is a volunteer-supported program that provides unbiased information to help Medicare beneficiaries make the best choices for their individual health care needs. The California Department of Aging administers HICAP services.
Call 1-800-434-0222
This has been an audio broadcast produced by California Health Advocates. Thanks for listening.