Last week, we discussed Medicare Parts A, B, C and D. If you have Medicare, it is now the time of year to review your Medicare plans because the Medicare Annual Open Enrollment Period will soon be upon us. The Annual Open Enrollment Period has remained the same this year as the last several years, October 15, 2016 to December 7, 2016
During this 7½ week period, you have the option to change existing Medicare Part D prescription drug plans and Medicare Part C Advantage plans. If you recall from last week, Part C Medicare Advantage plans are private insurance plans that replace traditional Medicare Parts A and B. The Medicare Open Enrollment overlaps with the Obamacare Health Insurance Marketplace Open Enrollment period of November 1, 2016 through January 31, 2017. 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.
There is also another period called the Medicare Advantage Disenrollment Period from January 1, 2017 through February 14, 2017. 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 also have until February 14, 2015 to join a Part D Medicare prescription drug plan to add drug coverage.
On February 15, 2016 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, which have special rules.
Before you decide what to do this year, you owe it to yourself to evaluate your options. 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.
You should have received or will be receiving an Annual Notice of Change for any pending Medicare plan changes that are to be effective in January, 2017. 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.
This year is especially important for those of you with the most popular Medicare Supplement plan in Michigan, the Blue Cross Legacy Medigap Plan C. Thanks to subsidies, most everyone was paying $122.86 per month. With subsidies ending and the plan going to market rates, there will be monthly rate increases of $48 to $192, for premiums of $170 to $315 per month. According to written reports, existing Legacy enrollees will have until December 15, 2016 to apply for state premium subsidies, but the Legacy Plan C will be forever closed to new enrollees on November 14, 2016. After that, new enrollees will be directed to other Blue Cross Medigap plans.
If you are Medicare eligible and do not have a Part D, prescription drug plan you may want to consider enrolling in a Part D 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.
Although the plan providers could only start marketing for their 2017 plans on October 1, 2016, you have probably seen the advertisements by providers getting a jump start by marketing their plans to “initial enrollees”. You will be getting a barrage of information. Medicare plans must follow certain rules when marketing their plans and getting your enrollment information. According to Centers for Medicare and Medicaid Services, Medicare plans aren’t allowed to:
- Ask for your Social Security Number, bank account number, or credit card information over the phone
- Come to your home uninvited to sell or endorse any Medicare related product.
- Offer you cash to join their plan or give you free meals while marketing to you.
- Enroll you in a drug plan over the phone unless you call them.
- Steer you into a particular plan.
- Communicate incorrect information about their plan type or use inappropriate statements like their plan is “the best” or “highest ranked.”
- Ask you for payment over the phone, internet, or in person. The plan must send you a bill.
- Call you unless you’re already a member of the plan. If you’re a member, the agent who helped you join can call you.
- Sell you a non-health related product, like an annuity or life insurance policy, while trying to sell you a Medicare health or drug plan.
- Make an appointment to tell you about their plan unless you agree in writing or through a recorded phone discussion to learn more about the products being discussed. During the appointment, they can only try to sell you the products you agreed to hear about.
- Talk to you about their plan in areas where you get health care, like an exam room, hospital patient room, or a pharmacy counter.
- Market their plans or enroll you during an educational event, like a health fair or conference.
- Offer an unapproved Medicare plan.
- Use false information to mislead you into joining a Medicare plan.
Be cautious when talking to Medicare “counselors” affiliated with an insurance company or other Medicare plan provider. They are NOT unbiased Medicare counselors; they are salespeople trying to get you to buy their plans. If you think a plan or an insurance agent is not following the rules, call 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048. Rather than talking to someone from an insurance company, you are much better off speaking with a certified Michigan Medicare Medicaid Assistance Program (MMAP) counselor.
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 or make an appointment with a certified MMAP counselor. When meeting with a MMAP counselor, always bring with you all of your current prescription bottles.
If you go online, you will see that the website has changed little from last year. For Medicare Part C Advantage plans and Medicare Part D prescription plans, click on the large rectangular green button on the left side that says “Find health & drug plans”. For Medicare Supplement plans, hover over the blue button at the top that says “Supplements & Other Insurance” and click on the dropdown menu “Find a Medigap policy”. 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. When you are done with all the questions, it will list and compare Medicare Part C Advantage plans, Medicare Part D prescription plans and/or Medigap policies.
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 else who can assist you. Three organizations in St. Clair County will have certified MMAP counselors to assist you this year, The Council on Aging, Inc., Lake Huron Medical Center and McLaren Port Huron.
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 and are making appointments on October 18, November 10 & 15 and December 6 & 7. They can be reached at 810-984-5061. They also have a contact at Washington Life Center in Marine City for seniors that reside in Marine City or who are homebound. The number for Washington Life Center is 810-765-3523.
Lake Huron Medical Center is doing a presentation on November 2 lead by a staff member who is a certified MMAP counselor. The program is open to the general public and gives an overview of Medicare plans.
McLaren Port Huron is also making 1-hour 1-on-1 MMAP counseling appointments to review Medicare Parts C & D plans and Medicare supplement policies on November 15 and December 1. Call HealthAccess at 800-228-1484 or 810- 989-3199 to make an appointment.
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 September 25, 2016 in The Times Herald newspaper, Port Huron, Michigan as: Medicare enrollment starts Oct. 15