You have probably seen the Medicare Advantage Plan commercials on the television. It is now the time of year to review your Medicare plans if you are over the age of 65. It is also the time of year for my annual column discussing the Medicare Annual Open Enrollment Period.
The Annual Open Enrollment Period has remained the same this year as the last several years, October 15, 2014 to December 7, 2014. During this 7½ week period, if you are eligible for Medicare, you have the option to change existing Medicare Part D prescription drug plans and Medicare Part C Advantage plans. Before you decide what to do this year, you owe it to yourself to evaluate your options.
Medicare consists of four parts — Part A, Part B, Part C and Part D. Most Medicare enrollees have Parts A and B. Part A includes hospitalization and rehabilitative care after hospitalization. Part B includes doctors’ visits, durable medical equipment and certain home healthcare services. Parts A and B are often called “Original” or “Traditional” Medicare. In addition, you may have an employer-sponsored or private pay Medicare supplement policy to go along with Parts A and B. The fourth part of Medicare is Part D or prescription drug coverage. You may think that the “D” in Part D is because of the word “drugs.” Actually, it’s because there is a Part C.
Part C is the Medicare Advantage program. It was started in 2003 as part of the Medicare Modernization Act, the same Act that created the Medicare Part D prescription drug coverage. The Medicare Advantage program is essentially a repackaging of the Medicare+Choice program which has been around since 1997.
With Medicare Part C Advantage plans, you have the private insurance versions of Medicare Parts A and B. If you have signed up for a Medicare Part C Advantage plan, you are no longer covered by Original Medicare Parts A and B even if you have your red, white and blue Medicare card. Your Medicare coverage is now governed by the private health insurance contract you entered into with the insurance company.
There is also another period called the Medicare Advantage Disenrollment Period from January 1, 2015 through February 14, 2015. During this period, if you are in a Medicare Part C Advantage plan, you can leave your plan and switch to Original Medicare Parts A and B. If your Medicare Part C Advantage plan included prescription drug coverage, you will have until February 14, 2015 to also join a Part D Medicare prescription drug plan to add drug coverage.
If you have just a Part D prescription plan, a change or cancellation to the drug plan cannot occur at this time. During this period, you also cannot switch Medicare Part C Advantage plans nor switch from Original Medicare Parts A and B to a Medicare Part C Advantage plan.
On February 15, 2015 and thereafter, Medicare institutes a lock-in period. During this time, generally no changes to Part D prescription drug coverage or Part C Advantage plans are allowed. As with most government programs there are a few exceptions to the rule when certain events happen in your life, such as if you move, lose other insurance coverage, are on Medicaid or live in an institution. These chances to make changes are called Special Enrollment Periods. Rules about when you can make changes and the type of changes you can make are different for each Special Enrollment Period.
So what’s the big deal? Why do you need to review your Medicare plan(s)? The reason is the insurance companies that sponsor the Medicare Parts C and D plans have the option to change what they offer each year and many of them do. Changes may come as a result of directives from Medicare, from previous years’ claims experience or from a multitude of other issues, which this year, includes new revelations about Obamacare.
The Obamacare Health Insurance Marketplace Open Enrollment period of November 15, 2014 through February 15, 2015 overlaps with the Medicare Open Enrollment period of October 15, 2014 through December 7, 2014. However, according to www.medicare.gov, if you are on Medicare, you do not need to do anything with the Obamacare Health Insurance Marketplace during its or Medicare’s Open Enrollment.
You should have received an Annual Notice of Change last month for any pending Medicare plan changes that are to be effective in January, 2015. You need to take the time to review the changes to be aware of the plans you are in and the benefits they provide when you might need to use the coverage.
If you are Medicare eligible, you may want to consider enrolling in a Part D prescription drug plan even if you do not currently take any prescriptions or ever had a drug plan before. If you do not sign up when you are first eligible and do not have other credible prescription drug coverage, you are subject to a monthly late enrollment penalty when you eventually do sign up.
This monthly penalty is equal to 1% of the “national base beneficiary premium” ($32.42 in 2014 and $33.13 in 2015) for each month you did not enroll, but could have, rounded to the nearest $.10 and added to your monthly premium. This monthly penalty continues so long as you have Part D prescription drug coverage, even for the rest of your life.
Starting October 1, 2014, the plan providers could start marketing for their 2015 plans. You will be getting a barrage of information from various plans. According to Centers for Medicare and Medicaid Services, “Medicare plans must follow certain rules when marketing their plans and getting your enrollment information. They can’t ask you for credit card or banking information over the phone, unless you’re already a member of that plan. Medicare plans can’t enroll you into a plan over the phone unless you call them and ask to enroll.
Call 1‑800‑MEDICARE (1‑800‑633‑4227) to report any plans that:
Ask for your personal information over the phone
Call to enroll you in a new plan
Use false information to mislead you
You can also call the Medicare Drug Integrity Contractor (MEDIC) at 1-877-7SAFERX (1-877-772-3379). The MEDIC helps prevent inappropriate activity and fights fraud, waste, and abuse in Medicare Part C Advantage Plans and Medicare Part D Prescription Drug Plans.
For more information on the rules that Medicare plans must follow, visit http://www.medicare.gov/Pubs/pdf/10111.pdf to view the booklet “Protecting Yourself & Medicare from Fraud.” You can also call 1‑800‑MEDICARE (1‑800‑633‑4227) to find out if a copy can be mailed to you. TTY users should call 1‑877‑486‑2048.”
So how do you wade through all this data? Well the first thing you need to do is make a list. The list should include all your current prescriptions, the name and address of your pharmacy, the names and amount of monthly premiums of your Medicare Parts C and D plans and Medicare Supplement/Medigap policy, if any. Armed with the list, you then go online to the government website, www.medicare.gov.
Once you get to the website you will see that it has changed a little from last year. For Medicare Part C Advantage plans and Medicare Part D prescription plans, you will still see a large rectangular green button on the left side that says “Find health & drug plans”. Click on the button, and then follow the directions.
Another series of buttons and questions will compare Medicare Supplement policies for you. In addition, there are other buttons on the web page that will also get you there. You will be guided through a number of questions which you will answer. When you are done with all the questions, it will list and compare Medicare Part C Advantage plans and Medicare Part D prescription plans.
Be careful when you sign up for Medicare Part D prescription coverage so you do not unknowingly also sign up for a Medicare Part C Advantage plan. Many seniors have inadvertently signed up for a Medicare Part C Advantage plan when they thought they were only signing up for a Part D prescription drug plan.
You may not have a computer, the website may be overwhelming to you or you may not have someone who can assist you. The folks at The Council on Aging in Port Huron are assisting seniors again this year in evaluating and choosing standalone Medicare Part D prescription drug plans that are not part of a Part C Medicare Advantage plan. They can be reached at 810-984-5061.
With the tools that are available to you, you should be able to find the most appropriate coverages at the most economical prices to meet your health care needs.
By: Matthew M. Wallace, CPA, JD
Published edited October 12, 2014 in The Times Herald newspaper, Port Huron, Michigan as: Medicare enrollment starts Wednesday