Dear Marci,
A Medicare & You handbook is mailed to me every year, but I’m never quite sure what I should do with it. How should I be using my Medicare & You handbook?
-Luis (Casper, WY)
Dear Luis,
I’m glad you asked! The Medicare & You handbook can be very helpful. The Medicare & You handbook is mailed to all Medicare households each September and contains information on Medicare benefits.
Here are some helpful uses for your handbook:
Learn what’s new with Medicare. It’s important to know about updates to your Medicare benefits and coverage. Remember that Medicare Advantage Plans must cover the same benefits that Medicare does; if you see a change in Medicare coverage rules in your Medicare & You book, you should expect to have those same benefits with your Medicare Advantage Plan, although with possibly different costs or restrictions (like requiring prior authorization).
Understand how to enroll. If you are new to Medicare, the Medicare & You handbook can be helpful in explaining how to sign up for the kind of coverage you want. It explains who will be automatically enrolled, and who will need to actively sign up for Parts A and B. The handbook lists instructions for enrolling in Medicare and offers resources to contact for assistance. It also contains information about choosing Part D or Medicare Advantage Plans, as well as Medigap options in your area.
Compare private plans in your area. While there is a general version of the handbook available online, the version mailed to you or sent to you electronically will contain information specific to the area in which you live. It should contain a list of Medicare Advantage Plans, Part D plans, and supplemental Medigap plans available in your area for you to compare.
Learn more about cost assistance programs. There are a variety of programs that help people save money on their Medicare. The Medicare & You handbook contains the eligibility guidelines (which are usually a person’s monthly or yearly income, and sometimes their assets) for these different programs. Use your handbook to see if you may be eligible for Extra Help, the Medicare Savings Program, or a State Pharmaceutical Assistance Program.
Learn about your rights. If you are denied coverage for a health service or item that you believe should be covered, your Medicare & You handbook contains helpful information on filing appeals. It additionally provides tips on protecting yourself from Medicare fraud and medical identity theft.
Use as a reference guide throughout the year. It is tough (and likely impossible!) to memorize everything about how Medicare works. Instead, keep your Medicare & You handbook to use as a reference guide as you need care throughout the year. The book contains an index of topics, as well as a dedicated section for finding out if Medicare covers your test, item, or service.
As you can see, the Medicare & You handbook can be helpful to you throughout the year. I highly recommend keeping it handy!
If you don’t receive your Medicare & You handbook by the end of September, you can call 1-800-MEDICARE (633-4227) and request that a copy with information for your area be sent to you. If you would like to receive your handbook electronically, you can log into (or create) your Medicare account to sign up for electronic handbooks. You can also download a general version of the handbook at Medicare.gov.
-Marci
Dear Marci,
Dear Marci,
When speaking to my insurance company, I was told to look out for an Annual Notice of Coverage in the mail. Can you tell me more about this?
-Sara (Greenville, SC)
Dear Sara,
An Annual Notice of Coverage (ANOC) is sent out by your Medicare Advantage Plan or Part D plan, and provides information about changes to your coverage in the upcoming year. It’s usually sent out around September, since it can help you decide if you want to make changes to your coverage during Medicare’s Fall Open Enrollment period, which runs from October 15th to December 7th.
There are three kinds of changes to look for in an ANOC:
Changes to your plan’s costs like premiums, deductibles, and copays.
Changes to the plan’s network that might affect coverage for your current providers and pharmacies
Changes to the plan’s formulary that might affect coverage of your current drugs or their prices.
After you’ve read about the changes to your coverage coming up in the new year, you can decide if your plan will still meet your needs or if you’ll want to change it during Fall Open Enrollment.
If you haven’t received your notice by September 30th, contact your plan to request a copy.
I hope that helps!
-Marci
When speaking to my insurance company, I was told to look out for an Annual Notice of Coverage in the mail. Can you tell me more about this?
-Sara (Greenville, SC)
Dear Sara,
An Annual Notice of Coverage (ANOC) is sent out by your Medicare Advantage Plan or Part D plan, and provides information about changes to your coverage in the upcoming year. It’s usually sent out around September, since it can help you decide if you want to make changes to your coverage during Medicare’s Fall Open Enrollment period, which runs from October 15th to December 7th.
There are three kinds of changes to look for in an ANOC:
Changes to your plan’s costs like premiums, deductibles, and copays.
Changes to the plan’s network that might affect coverage for your current providers and pharmacies
Changes to the plan’s formulary that might affect coverage of your current drugs or their prices.
After you’ve read about the changes to your coverage coming up in the new year, you can decide if your plan will still meet your needs or if you’ll want to change it during Fall Open Enrollment.
If you haven’t received your notice by September 30th, contact your plan to request a copy.
I hope that helps!
-Marci
Dear Marci,
Dear Marci,
My doctor put me on a few new medications and my drug costs are becoming more difficult to afford. Is there any way to reduce my Part D costs?
– Arjun (Reno, NV)
Dear Arjun,
I’m sorry to hear that! That’s a concern for so many. There are a few programs and strategies that might help you save money on your prescriptions.
If your income is below $1,903 per month as an individual, or $2,575 if married, and you also have limited assets, you could be eligible for Extra Help. Extra help is a cost-assistance program that can help you pay for your prescription drugs and pays for a portion of your Part D premium.
There are also State Pharmaceutical Assistance Programs (SPAPs) offered by most states that can help you pay for your prescription drugs. Some SPAPS also help pay for your Part D plan’s premium, deductible, and/or copays. Check this list of State Pharmaceutical Assistance Programs to find out if your state has an SPAP, to find out if you’re eligible, and how to enroll. You can also contact your State Health Insurance Assistance Program (SHIP) to learn about possible SPAPs in your state.
If you do not qualify for these programs, check out these other options and strategies for those who are having trouble affording drug costs. For example, some of your medications may have manufacturer discounts or coupons that you can find on www.NeedyMeds.org.
Also note that beginning in 2025, your Part D our out-of-pocket costs will be limited to $2,000 in deductibles, copays, and coinsurance. Learn more about Part D changes due to the Inflation Reduction Act here.
Best of luck,
-Marci
My doctor put me on a few new medications and my drug costs are becoming more difficult to afford. Is there any way to reduce my Part D costs?
– Arjun (Reno, NV)
Dear Arjun,
I’m sorry to hear that! That’s a concern for so many. There are a few programs and strategies that might help you save money on your prescriptions.
If your income is below $1,903 per month as an individual, or $2,575 if married, and you also have limited assets, you could be eligible for Extra Help. Extra help is a cost-assistance program that can help you pay for your prescription drugs and pays for a portion of your Part D premium.
There are also State Pharmaceutical Assistance Programs (SPAPs) offered by most states that can help you pay for your prescription drugs. Some SPAPS also help pay for your Part D plan’s premium, deductible, and/or copays. Check this list of State Pharmaceutical Assistance Programs to find out if your state has an SPAP, to find out if you’re eligible, and how to enroll. You can also contact your State Health Insurance Assistance Program (SHIP) to learn about possible SPAPs in your state.
If you do not qualify for these programs, check out these other options and strategies for those who are having trouble affording drug costs. For example, some of your medications may have manufacturer discounts or coupons that you can find on www.NeedyMeds.org.
Also note that beginning in 2025, your Part D our out-of-pocket costs will be limited to $2,000 in deductibles, copays, and coinsurance. Learn more about Part D changes due to the Inflation Reduction Act here.
Best of luck,
-Marci
Dear Marci,
Dear Marci,
My pharmacist mentioned that I might be able to get onto a program called Extra Help. Can you explain the benefits of enrolling in this program?
-Malcolm (Houston, Tx)
Dear Malcolm,
Extra Help is a cost-assistance program that helps you pay for prescription drugs while on Medicare. It works by paying for your Part D premium (up to a state-specific benchmark amount) while lowering the cost of you prescription drugs.
Note: You pay no premium if you have a basic Part D drug plan with a premium at or below the Extra Help premium limit for your area. You will likely still owe a premium, though, if you have an enhanced Part D plan, even if the premium is below the benchmark.
Some extra perks are that if you qualify for Extra Help and happen to have a Part D late enrollment penalty, it will eliminate that fee. It also gives you Special Enrollment Periods throughout the year to enroll in a Part D or switch between plans.
You should automatically be enrolled in Extra Help if you have Medicaid, Supplemental Security Income, or a Medicare Savings Program. If that’s not the case for you, you might still be eligible if you have limited assets and your income is below $1,903 per month as an individual, or $2,575 as part of a couple.
Apply online through the Social Security Administration or contact the Medicare Rights Center for assistance applying.
I hope that helps!
-Marci
My pharmacist mentioned that I might be able to get onto a program called Extra Help. Can you explain the benefits of enrolling in this program?
-Malcolm (Houston, Tx)
Dear Malcolm,
Extra Help is a cost-assistance program that helps you pay for prescription drugs while on Medicare. It works by paying for your Part D premium (up to a state-specific benchmark amount) while lowering the cost of you prescription drugs.
Note: You pay no premium if you have a basic Part D drug plan with a premium at or below the Extra Help premium limit for your area. You will likely still owe a premium, though, if you have an enhanced Part D plan, even if the premium is below the benchmark.
Some extra perks are that if you qualify for Extra Help and happen to have a Part D late enrollment penalty, it will eliminate that fee. It also gives you Special Enrollment Periods throughout the year to enroll in a Part D or switch between plans.
You should automatically be enrolled in Extra Help if you have Medicaid, Supplemental Security Income, or a Medicare Savings Program. If that’s not the case for you, you might still be eligible if you have limited assets and your income is below $1,903 per month as an individual, or $2,575 as part of a couple.
Apply online through the Social Security Administration or contact the Medicare Rights Center for assistance applying.
I hope that helps!
-Marci
Dear Marci,
Dear Marci,
I’ll be turning 65 next month and will need to enroll in Medicare. Do I need to do this by next month?
– Mira (Coupeville, WA)
Dear Mira,
Good question! That depends on a few things. If you’re already receiving retirement benefits from the Social Security Administration or Railroad Retirement Board, you should automatically be enrolled in Medicare Parts A and B. Otherwise, you will need to actively enroll by contacting the Social Security Administration. There are three times when you can enroll in Parts A and B for the first time:
Your Initial Enrollment Period (IEP): The three months before, the month of, and the three months after your 65th birthday are your Initial Enrollment Period. Because your birthday is in July, your IEP started April 1, and will end at the end of October. . If you enroll in the first 3 months of your IEP, your coverage starts the first month of your birth month, if you enroll in later months, your coverage starts the first day of the next month. If you want your coverage to begin as soon as possible—July 1—you should enroll before the end of this month.
A Special Enrollment Period (SEP): If you decide not to enroll during your Initial Enrollment Period, you may be able to enroll later during an SEP, which is based on specific circumstances. One SEP allows people who are covered by health insurance as a result of their or their spouse’s current work to enroll after their IEP has ended. To use that SEP, a person must be covered by employer-based insurance (or Part B) when they first became eligible for Medicare, and may not have a gap in employer insurance or Part B of more than 8 months. If you are currently covered by employer-based insurance, you may wish to delay enrolling in Medicare, and you will be able to enroll later as long as you qualify for the SEP. Whether this is a good idea for you will also depend on coverage and cost of your employer insurance, including whether that insurance is required to pay claims for people who are eligible for but not enrolled in Medicare.
The General Enrollment Period (GEP): If you do not enroll during your IEP and do not have an SEP, you can enroll during the annual GEP, which runs from January 1 to March 31. Many people who enroll during the GEP experience coverage gaps as they wait for the January 1 start of the enrollment period, and may face late enrollment penalties depending on the length of time between their IEP and enrollment during the GEP.
Medicare prescription drug coverage, Part D, has separate enrollment rules. The Part D Initial Enrollment Period is usually the same as your Medicare IEP. However, if you delay enrollment in both Part A and Part B (or if you live outside of the service area of any plan and are therefore not eligible to enroll in a Part D plan), your Part D IEP will be the 7 months surrounding your eligibility–triggered by enrollment in Part A or Part B or your move into the service area of a plan. If you have “creditable” drug coverage, you can decline Part D without a later penalty, but you may have to wait until the Annual Election Period (also known as “Fall Open Enrollment”) from October 15 through December 7, unless one of the Part D-related SEPs is applicable.
Best of luck!
-Marci
I’ll be turning 65 next month and will need to enroll in Medicare. Do I need to do this by next month?
– Mira (Coupeville, WA)
Dear Mira,
Good question! That depends on a few things. If you’re already receiving retirement benefits from the Social Security Administration or Railroad Retirement Board, you should automatically be enrolled in Medicare Parts A and B. Otherwise, you will need to actively enroll by contacting the Social Security Administration. There are three times when you can enroll in Parts A and B for the first time:
Your Initial Enrollment Period (IEP): The three months before, the month of, and the three months after your 65th birthday are your Initial Enrollment Period. Because your birthday is in July, your IEP started April 1, and will end at the end of October. . If you enroll in the first 3 months of your IEP, your coverage starts the first month of your birth month, if you enroll in later months, your coverage starts the first day of the next month. If you want your coverage to begin as soon as possible—July 1—you should enroll before the end of this month.
A Special Enrollment Period (SEP): If you decide not to enroll during your Initial Enrollment Period, you may be able to enroll later during an SEP, which is based on specific circumstances. One SEP allows people who are covered by health insurance as a result of their or their spouse’s current work to enroll after their IEP has ended. To use that SEP, a person must be covered by employer-based insurance (or Part B) when they first became eligible for Medicare, and may not have a gap in employer insurance or Part B of more than 8 months. If you are currently covered by employer-based insurance, you may wish to delay enrolling in Medicare, and you will be able to enroll later as long as you qualify for the SEP. Whether this is a good idea for you will also depend on coverage and cost of your employer insurance, including whether that insurance is required to pay claims for people who are eligible for but not enrolled in Medicare.
The General Enrollment Period (GEP): If you do not enroll during your IEP and do not have an SEP, you can enroll during the annual GEP, which runs from January 1 to March 31. Many people who enroll during the GEP experience coverage gaps as they wait for the January 1 start of the enrollment period, and may face late enrollment penalties depending on the length of time between their IEP and enrollment during the GEP.
Medicare prescription drug coverage, Part D, has separate enrollment rules. The Part D Initial Enrollment Period is usually the same as your Medicare IEP. However, if you delay enrollment in both Part A and Part B (or if you live outside of the service area of any plan and are therefore not eligible to enroll in a Part D plan), your Part D IEP will be the 7 months surrounding your eligibility–triggered by enrollment in Part A or Part B or your move into the service area of a plan. If you have “creditable” drug coverage, you can decline Part D without a later penalty, but you may have to wait until the Annual Election Period (also known as “Fall Open Enrollment”) from October 15 through December 7, unless one of the Part D-related SEPs is applicable.
Best of luck!
-Marci