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Advice & More August 2012

Dollar Sense

Medicare Open Enrollment is Right Around the Corner: Should You Change Your Plan or Stick With the Old One?

By Teresa Ambord

Take some time to reconsider the plan you’ve chosen and you may be able to improve your benefits, or lower your premiums, or both. Or perhaps you just need to tweak your plan to suit your current medical needs.

Coming up soon – October 15 through December 7th -- seniors and disabled persons on Medicare will have the opportunity to decide whether or not their current Medicare plans are meeting their needs.

If you are currently enrolled in Medicare Advantage (also known as Medicare Part C), or a Part D prescription drug plan, this is your chance to look around and see if you can do better. Take some time to reconsider the plan you’ve chosen and you may be able to improve your benefits, or lower your premiums, or both. Or perhaps you just need to tweak your plan to suit your current medical needs.

Also during this period, individuals who are already Medicare eligible but not yet enrolled in Medicare Advantage, can sign up in a new plan. And those who are participating in a Medicare Advantage or a Medicare Part D plan can cancel during this period. What if you miss your annual window of opportunity to make changes? You will need to wait till next year. So let this be a strong reminder, don’t miss this opportunity. Assuming you are happy with your current plan, why should you change or consider changing?

Because other things change, including your health care needs, your prescriptions, the benefit options, your geographic location, and possibly the premiums charged by insurers. It’s natural to be leery of change, especially if you have not been unhappy with your plan as it is. But this is an opportunity to gain control over high health costs, possibly improve what you are getting, and tweak your plan to meet your personal medical needs.

Here is a list from Medicare.gov of actions you can take during Open Enrollment:

  • You can join a Medicare prescription drug plan.
  • You may wish to drop Medicare prescription drug coverage completely.
  • You may switch from one prescription drug plan to another, within the Medicare plans.
  • You may switch from original Medicare to Medicare Advantage, or vice versa, from Medicare Advantage to original Medicare.
  • You may switch from one Medicare Advantage plan to another Medicare Advantage plan.
  • If you are in a Medicare Advantage plan that does not have drug coverage you made switch to one that does.

Confused About How to Decide?

First, don’t assume nothing has changed. Competition in the health care field may have forced insurers to rethink what they offer. You can get advice from an insurance agent who is a licensed insurance broker specializing in Medicare. Just be sure that the agent is not tied to a particular company, so that he or she has a more objective, broader spectrum of options for you. Friends and family may be able to help. But remember, what works for someone else’s health needs may not work for yours.

You can do some research on your own by logging onto Medicare.gov, or talk to someone at 800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

However you make your decision, here are some points to compare:

  • Monthly premiums
  • Out of pocket expenses
  • All deductibles
  • Co-payments
  • Coinsurance

Also consider how your health care needs may have changed since you last chose a plan.

  • How frequently do you see your doctors?
  • What ongoing prescriptions do you take that may be new?
  • Has your current plan notified you of any upcoming changes that affect you adversely?

Suppose you make a change on October 15th, and later, during the open enrollment period discover you’ve made a mistake — what then? As long as you are still within the Open Enrollment period you may make as many changes as you wish. Only the last one will count, and those final changes will take effect on January 1st, 2013, allowing you to use your Part D benefits. Your old plan will automatically discontinue.

Disenrollment Period

If for some reason you want to leave Medicare Advantage to return to original Medicare, you may do so from January 1, 2013, to February 14, 2013, and select a stand-alone Medicare Part D plan. Your coverage under your new plan will begin the first day of the month following the time your enrollment form is received. According to Medicare.gov, here are a few things you cannot do during the Disenrollment Period.

You cannot:

  • Switch from Original Medicare to a Medicare Advantage Plan
  • Switch from one Medicare Advantage Plan to another
  • Switch from one Medicare Prescription Drug Plan to another
  • Or join, switch, or drop a Medicare Medical Savings Account Plan.

Sidebar: Special Enrollment Periods

There are also Special Enrollment Periods (SEPs) that are available when certain events occur to change your coverage or eligibility. Examples would include events like changes in your living arrangements, such as if you moved to an area that is not served by your plan, if you return to the United States after living elsewhere, just left a nursing home, or were released from jail.

SEPs may also be available if you lose your current coverage, have a chance to change your coverage (such as being offered coverage through an employer), and more. To see if your situation qualifies for special enrollment, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Medicare also offers more specifics at http://www.medicare.gov/Publications/Pubs/pdf/11219.pdf.

You can also get more personalized information to suit your situation by logging onto Medicare.gov. Here are some tools provided to help you understand your options.

  • Medicare Eligibility Tool: Provides Medicare eligibility status information. Select “New to Medicare?” and then “Find Out if You’re Eligible.”
  • Medicare Plan Finder: Provides personalized information about available Medicare Prescription drug plans, Medicare Advantage Plans, other Medicare health plans, and Medicare supplement insurance (medigap) policies. Visit www.medicare.gov/find-a-plan.

Sidebar: Newly Eligible?

Those who turn 65 in 2013 can enroll in Medicare Part D and have a seven-month window to enroll. The seven months begin three months before the individual’s birthday, the month which includes the birthday, and three months after. So a person who turns 65 in September of 2013 can enroll in June through December 2013.

To be sure your benefits begin by your birthday you must sign up in the three-month period prior, otherwise, benefits will be delayed. The best policy is to sign up at the earliest opportunity.

 

Teresa Ambord is a former accountant and Enrolled Agent with the IRS. Now she writes full time from her home, mostly for business, and about family when the inspiration strikes.

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