Medicare Open Enrollment is just weeks away – October 15 through December 7— and it’s your chance to make changes to your coverage if you want to. If you do make changes, they will become effective in January. But should you change?

Medicarerights.org knows this can be a confusing time. They offer what they call “tried and true” advice. Overall, since you can only make changes during Open Enrollment, Medicare urges people to carefully consider their options.

• If you have Original Medicare and a supplemental plan and are happy with your coverage, you do not need to change.
• If you’re not happy with your coverage, shop around for the plan that meets your needs.
• If you have Medicare Advantage or Part D, you should know the costs change yearly so
  review your coverage yearly.
• Be sure to read your Annual Notice of Change for cost changes. You should have received this notice by September 30.
• If you decide to change your coverage, don’t call the plan. Instead call 800-MEDICARE. When you speak with a representative, take notes on what you are told, the date, and the name of the person you spoke with.

You may also have to pay higher premiums if you did not enroll in Part B or D when you first became eligible, due to premium penalties for late enrollment.

What’s New for 2016? What Remains the Same?

Part B Premiums

For most Medicare beneficiaries, the Part B premium will remain at $104.90 per month. But for about 30% of Medicare beneficiaries, Part B will rise to $159.30 per month. Ouch! Who is affected by the price increase?

• People who enroll in Medicare in 2016 and do not collect Social Security.
• People who have higher incomes, over $85,000 for individuals and over $170,000 for couples.
• You may also have to pay higher premiums if you did not enroll in Part B or Part D when you first became eligible. Your premiums will be higher because they will include a penalty for late enrollment.

You should know, if you go to Plan Finder on the Medicare.gov website, the premiums listed there are the basic premiums, not those for higher income people.

Sometime this fall the final figures for Part B premiums will be announced, in time for you to use that information in making your Medicare decisions during Open Enrollment, so if you suspect you will be subject to higher premiums you may want to wait for the release of the new figures to make your decisions.

Medicare also wants you to know that Medicare Advantage plans are improving, according to the Kaiser Family Foundation. In 2013 only 37 % were rated at 4 to 5 stars. In 2014 that rose to 52%. And for 2015, 61% achieved 4 to 5 stars. While this is just one part of the decision you need to make about your Medicare, it’s an important part.

Part D

Your Part D Medicare prescription drug plan premium will remain at $32.50 for 2016, though it may vary with your plan or the region you live in. You will know if your costs have changed when you receive your Annual Notice of Change by September 30.

Medicare beneficiaries will still receive a 55% discount on the cost of brand-named drugs during the doughnut hole period, and a discount of 35% to 42% on generic drugs.

When you’re considering possible changes in your Medicare plan, be aware that the list of covered drugs changes year to year and restrictions may change, such as quantity limits and authorizations for certain drugs.

How the Affordable Care Act May Affect You in Relation to Medicare

Do you have a Qualified Health Plan through the Affordable Care Act – also called Exchanges or the Marketplace  – in other words, plans that you shop for and buy online, since health care reform was mandated. You should know how the Marketplace relates to Medicare, so you can avoid bogus plans or plans that will leave you uncovered.

• It is illegal for someone to sell you a Marketplace policy if they know you have Medicare. Regardless of what you are told by a salesperson, as a Medicare recipient you are not eligible for any tax credits to help pay for Marketplace insurance.
• If you drop Medicare to take a Qualified Health Plan, there’s no guarantee that plan will pay for your medical costs. In many cases, a Qualified Health Plan has the right to refuse to pay costs for someone eligible for Medicare, and that means you’ll be left with no coverage at all.
• Also, you should know that the Marketplace does not sell Medicare Advantage plans, Medigap supplements, or standalone Part D plans.

Remember, if you need help with your decisions about Medicare or when you are ready to change, call 800-MEDICARE to speak to a representative. You can also log onto Medicare.gov by going to https://www.medicare.gov/Contacts/ and look for a representative in your area.

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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