OPEN ENROLLMENT RESOURCE CENTER FOR PEOPLE WITH MEDICARE

Annual Election Period: October 15, 2015 – December 7, 2015

The Affordable Care Act has not had the same impact on Medicare-related products that it has had on health insurance sold to individuals or to employers. Still, there are some important changes. Most notably, the ACA expanded the preventive services that are covered under Medicare and, over time, will close the Medicare Part D coverage gap, also known as the “donut hole.”

What changes can you make during open enrollment?

The open enrollment period for people with Medicare, better known as the Annual Election Period (AEP), begins October 15th and ends December 7th.

During this time, you can:

• Purchase a Medicare Advantage plan
• Change to a different Medicare Advantage plan
• Drop your Medicare Advantage plan and return to Original Medicare
• Purchase a Medicare Part D prescription drug plan
• Change to a different Medicare Part D plan
• Drop your Part D coverage

We never recommend dropping Medicare Part D unless you have a drug plan available to you through an employer that is considered “creditable coverage.” If you have Medicare, do not sign up for Medicare Part D, and do not have other creditable coverage through an employer, you could be charged a penalty of 1% per month for every month you were eligible for Part D coverage but not enrolled, and the penalty will continue for the rest of your life.

Also, while Medicare supplements are not subject to the same Annual Election Period as Medicare Advantage and Part D plan, if you do intend to drop your Medicare Advantage Plan and return to Original Medicare during the AEP, we would recommend that you purchase a supplement at the same time. Note that insurance companies providing Medigap plans can ask you medical questions and decline to offer you coverage. You only have a small window of time when you first get Medicare Part B to purchase a supplement on a guaranteed-issue basis. Your JME agent can help you with this decision.

What is a Medicare Advantage Plan?

A Medicare Advantage Plan allows you to receive your Medicare benefits through a private insurance company rather than having Medicare pay the bills. When you sign up for an Advantage plan, the Medicare program pays the insurance company a set fee each month to provide your medical coverage, and, depending on the plan, you may owe an additional premium. You will also need to keep paying for Medicare Part B (usually but not always out of your Social Security check) while on an Advantage plan.

To qualify for an Advantage plan, you must have Medicare Parts A and B, must live in the plan’s service area, and must not have End Stage Renal Disease (ESRD).

Medicare Advantage plans must cover the same benefits as Medicare and may provide additional benefits. They usually have provider networks and may require you to choose a primary care physician and receive a referral to see a specialist. Many Advantage plans provide more out-of-pocket protection than Original Medicare, offering up-front copayments for doctor visits and prescriptions, requiring deductibles and coinsurance for more expensive procedures, and limiting your total exposure for the year. They’re also less expensive than a Medicare supplement and Medicare Part D plan but may require higher cost sharing at the point of service.

Your JME agent can explain your options and help you determine if a Medicare Advantage plan is right for you.

How do I choose a Medicare Part D Prescription Drug Plan?

Medicare Part D is confusing for a lot of people because there are so many options to choose from; there are a lot of competitors, and some insurance companies offer a low, medium, and high option. There are also a lot of factors to consider when comparing your options, including the annual deductible, if any, the cost-sharing for each coverage tier, the plan’s prescription drug formulary (preferred drug list), and the list of participating pharmacies.

Because everyone’s situation is different, the best way to find a Medicare Part D plan is to compare your options on the Medicare.gov website. Through the site, you can enter your zip code; provide details about any other coverage you might be eligible for (such as employer-sponsored coverage, a retiree plan, or Extra Help); indicate which pharmacies you prefer; and enter the name, strength, and frequency of each of your prescription medications. The site will show you all of the Part D options available to you, will estimate your annual premium and out-of-pocket costs, will show you ratings for each of the plans, and will even allow you to save your search.

Once you’ve compared your options on the Medicare.gov website, one of our agents can help you sign up for coverage if we work with the insurance company. If not, we can provide guidance about how to sign up for coverage.