The only time** Medicare beneficiaries can make changes in their health insurance plan or their Part D drug plan is during each year’s “open enrollment” period – from Oct. 15 through Dec. 7. Any changes you make will take effect on Jan. 1, 2017.
Even if you’re happy with your current coverage, you could save money by reviewing your coverage. Health care needs can change from year to year. Be sure you have the best plan for your current needs. Also, insurance companies can change what your plan covers, making it no longer the best (or cheapest) plan for you. Part D drug plans frequently change the list of drugs they cover.
Four options during open enrollment:
- Change to a different prescription drug plan (Medicare – Part D). If you have original Medicare, there are 22 drug plans available to Arkansans this year. The average monthly premium for a basic drug plan will increase by about $1.50 to $34. Monthly premiums will range from $15.70 to $134. The drugs that each plan covers (called a formulary) change frequently so be sure your drugs are covered. Also, be sure your preferred pharmacy is in the plan’s network. Thanks to the Affordable Care Act, you’ll enjoy more savings on your prescriptions in 2017 if you land in the coverage gap, known as the “doughnut hole.” The doughnut hole begins once you and your drug plan have spent $3,700 for your medications. In 2017, you’ll receive a 60 percent discount on your brand-name drugs and a 49 percent discount on your generic drugs while in the gap.
- Leave original Medicare and switch to a private Medicare Advantage (MA) plan. MA plans must provide health benefits that are equal to or better than original Medicare. Because private insurance companies run MA plans, they can offer services in addition to the basic Medicare benefits (like vision and dental coverage). You will pay more for these extra services. Call Medicare at 800-633-4227 to get a list of MA plans available in your area. Visit the plans’ websites for more details. Make sure the plan’s network of preferred providers includes your doctors, hospitals and pharmacies in its network. You’ll pay more to use providers outside the plan’s network. If the MA plan you choose includes drug coverage, you do not need a separate Part D plan.
- Leave a MA plan and return to original Medicare. Original Medicare lets you choose any doctor or hospital. If you go back to original Medicare, you will also need to choose a stand-alone Part D drug plan. You may also want to buy a Medigap policy that helps pay the costs that original Medicare does not cover. You are not required to buy a Medigap policy (formally called Medicare supplement insurance). Medigap policies are sold by private insurance companies to fill the gaps in coverage that original Medicare does not pay. Original Medicare pays its share, and the Medigap policy pays all or part of the remaining costs, including co-payments, coinsurance and deductibles. Some policies pay for additional services not covered by Medicare. You pay extra for Medigap coverage. Remember, you only need one Medigap policy; the law only permits you to have one policy. Medigap benefits for all policies are standardized into 10 different plan options. Not all companies sell all 10 plans. Be sure you understand the plans’ differences so you don’t pay for more services than you need. You are guaranteed the right to buy a Medigap policy, but there are several conditions. When you are new to Medicare, you must enroll in a Medigap policy within six months from the time you are enrolled in Part B Medicare and are age 65 or older. During this period, you cannot be denied a policy based on your health status, nor can the insurance company impose a pre-existing waiting period based on your medical history. If you are leaving a MA plan and returning to original Medicare, you are considered to have lost coverage. You have 63 days from the time you lost coverage to enroll in a Medigap plan. You are also guaranteed the right to enroll in a Medigap plan if you, for example, enroll in a new Medigap plan because your previous plan or medigap-type coverage (from an employer) goes out of business or changes its services. If you enroll in a MA plan, disenroll within 12 months and enroll in Medicare you are also guaranteed Medigap enrollment. You do not need a Medigap policy if you join an MA plan.
- Change from one MA plan to a different MA plan.
To be a savvy consumer and possibly save money, evaluate more than just monthly premiums. Be sure your doctors and other health care providers accept Medicare. Also, compare costs for deductibles, co-payments and coinsurance costs. When considering a drug plan, make sure it includes all your medications and in the dosages you need.
Ready to review:
Step one – Be sure you have received either an Annual Notice of Change or Evidence of Coverage from your current health plan – either your Part D plan or from a MA plan. If you have original Medicare, you will not receive this notice. Review the notice (s) for changes in the plan’s costs, benefits, what your out-of-pocket costs could be and rules for 2017.
Step two – If you have a free-standing (drug coverage that is not included in another policy) Part D drug-plan, make a list of all your prescriptions’ names and the current dose you take.
Step three – Visit Medicare’s website. This is the best tool to help you narrow your search for a new health or drug plan. Just click on “Find Health and Drug Plans.” Enter your ZIP code and your prescriptions. Use the “Medicare Plan Finder” tool to compare your coverage and out-of-pocket costs under different plans. If you’re not comfortable doing this on your own, contact one of the three free sources of help below.
Step four – Evaluate the plans. Medicare Plan Finder provides a star-rating method that is based on quality of care and customer service. Quality is indicated with a star (s); a gold-star plan has the highest, five-star rating. A warning icon will alert you to plans that have performed poorly for at least the last three years.
For more help
In addition to the Medicare.gov website, you can call Medicare’s toll-free help line at 1-800-633-4227 or consult your Medicare & You 2017 Handbook, which you should have received in the mail.
One-on-one benefits counseling is available through the Senior Health Insurance Information Program (SHIIP) at 1-800-224-6330 or 501-371-2782.
You can also receive free, individual counseling about Part D from your local Area Agency on Aging (AAA). Click here for an Arkansas map indicating the AAA that serves your county. Call today to make an appointment for Part D counseling.
Help paying for medications
If you have problems affording your medications, you may qualify for extra help with your drug coverage premiums, deductibles and co-payments. Almost 40 percent of Arkansas seniors with Part D plans receive this extra help. The amount of help depends on your income and resources. Generally, you’ll pay no more than $3.30 for generic drugs and $8.25 for brand-name drugs. For more information about how to qualify for extra help, visit Social Security’s website or call Social Security at 1-800-772-1213.
Not the Marketplace
Younger Americans, who get their health insurance through the Health Insurance Marketplace established under the Affordable Care Act, also have their open enrollment in the fall and winter. However, the Marketplace process does not affect Medicare beneficiaries.
**There are exceptions to this rule for special situations like moving, changing jobs, etc.