Get Ready for Medicare Enrollment!

Seattle -- Fall Open Enrollment Period, during which people with Medicare can make unrestricted changes to some of their Medicare coverage options, takes place from October 15 to December 7.

Don't plan to wait until the end of December to make a change since the open enrollment period ends on December 7. In fact, begin your decision process early.

“This is the time of year to make sure you have the best plan that meets your needs,” says Ron House, Statewide Health Insurance Benefits Advisors (SHIBA) Acting Program Manager. “Our SHIBA volunteer counselors can help you understand your choices. Also, with health reform, a lot of folks on Medicare have questions about whether or not they should go to the state's new health insurance Exchange to re-enroll in their Medicare plan. The answer is no, Medicare is not part of the new Exchange. The Exchange is for people under age 65 NOT on Medicare.”

SHIBA, which is a free, unbiased service of the Washington State Office of the Insurance Commissioner, helps people answer questions and evaluate plans. “Our trained volunteer counselors in your community can answer your questions and search for plans online,” said Ron House. “We also offer assistance with Original Medicare and other health plans, and provide free, unbiased information to help you decide.”

The Medicare Rights Center says that if there is one mantra for the open enrollment season, it’s “review your options.” Carefully consider your decision as most people are allowed to make a change only during Fall Open Enrollment.

Certain universal advice applies, no matter what Medicare coverage you have:

• Review the 2014 Medicare & You handbook. You should receive it in mid-October.

• You should review all of your coverage options even if you are happy with your current coverage, because plans change their costs and benefits every year.

• Read all letters and notices from your current plan, as well as your Annual Notice of Change (ANOC), which you should have received by September 30. It will list the changes in your plan, such as the premium and copays, and will compare the benefits in 2014 with those in 2013. It is very important that you read your ANOC carefully and consider all of your options. Your current plan may not offer your best choice for 2014.

• Shop around to find a plan that best meets your needs and makes the most financial sense to you. Do your homework and make an informed decision.

• If you have questions, call 1-800-MEDICARE (1-800-633- 4227) or SHIBA (1-800-562- 6900) before you sign up.

• If you decide to enroll in a new plan, do so by calling 1-800-MEDICARE or call the plan directly.

Medicare Advantage Plans

If you are considering a Medicare Advantage (MA) plan, make sure you understand how it works. Take the time to ask questions, such as:

• Will I be able to use my doctors or other providers I want to see?

• Are the doctors I want in the plan’s network and are they taking new patients who have this plan?

• Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan’s network?

• What are the co-pays for physicians, specialists, and hospital stays?

• Does the plan include drug coverage? (more information on drug coverage below).

Difference between Medigap and Medicare Advantage Plans

You must be enrolled in Original Medicare Parts A & B to qualify for Medicare Supplement Plans or Medicare Advantage plans. Medicare Supplement plans are sometimes called Medigap. Medigap is a private insurance plan that helps cover out-of-pocket expenses such as deductibles and coinsurance that Medicare doesn’t pay.

If you choose instead to join a Medicare Advantage Plan, you are choosing to contract with a private insurer that replaces your Original Medicare plan – Medicare Advantage is designed to be an all-in-one plan.

If you have Original Medicare plus a Medigap plan, be very careful if you decide to drop it –you may not be able to get it back later.

Medicare Advantage plans may include prescription drug coverage. Medigap plans don’t include prescription drug coverage, but you will still be able to buy a standalone drug plan during Annual Enrollment.

Drug Coverage Options

Drug coverage may be as a stand-alone prescription drug plan (PDP) to go with Original Medicare, or it may be part of an MA plan that includes drug coverage (MAPD).

• Make a list of all current prescription drugs you take, the doses, and how often.

• Whether you are considering a new plan or thinking of staying in your old plan, review your ANOC and pay particular attention the summary of the new formulary (list of covered drugs).

• Then, use the Plan Finder at www.medicare.gov to compare Part D plans or Medicare Advantage Plans with Drugs (MAPD). If you use the online Plan Finder tool at www.medicare.gov to select the best plan for your needs, call the plan and confirm the information you’ve gathered with a plan representative. This will protect you if you discover that the information on which you based your decision to enroll in a plan was inaccurate.

• If you have limited income and need help paying for prescription drugs, check out Social Security’s “Extra Help” program. To see if you qualify, contact the Social Security Administration at 1-800-772-1213 or go to www.socialsecurity.gov and click on Medicare.

Making a decision about the best Medicare plan for you is an important decision. Whatever you do, don’t wait until the end of the enrollment period to get help,” says SHIBA’s acting program manager Ron House. “Call our Insurance Consumer Hotline today at 1-800-562-6900 and ask to schedule an appointment with a SHIBA volunteer advisor in your area.”

SHIBA also provides resources to find free Medicare workshops in your local area. To learn more, visit www.insurance.wa.gov/shiba or call 1-800- 562-6900 for more information.

Information for this article was gathered from Washington State’s Statewide Health Insurance Benefits Advisors (SHIBA), the Medicare Rights Center, and Families USA.