Dear Marci,

What changes can I make during Fall Open Enrollment?

– Herman (Chattanooga, TN)

Dear Herman,

Fall Open Enrollment, also known as the Annual Election Period, runs from October 15 to December 7 each year. This is the time of the year when Medicare beneficiaries can make changes to their existing coverage.

If you are enrolled in a Medicare Advantage Plan or a stand-alone Part D plan, your plan should send you an Annual Notice of Change (ANOC) that lists any changes to your plan for 2017. These changes could be that the plan will charge a different monthly premium, cover different services, or change its formulary (the plan’s list of covered drugs).

You should read this notice carefully to see if any of the changes affect you. For instance, if your ANOC tells you that your Part D plan will have an annual deductible next year, you may want to choose a new Part D plan that does not have a deductible.

There are a number of changes you can make during Fall Open Enrollment. You can:

• Switch from Original Medicare to a Medicare Advantage Plan (also called Part C)
• Switch from a Medicare Advantage Plan back to Original Medicare
• Switch from your current Medicare Advantage Plan to a new one
• Join a Part D prescription drug plan (if you do not have one)
• Switch from your current Part D prescription drug plan to a new one
• Do nothing and stay with your current coverage

Any changes you make will become effective January 1, 2017. You can make as many changes as you like during Fall Open Enrollment, but only the last change you make will be effective in January.

If you have questions about your coverage, plan options, or just need help in general, there are a number of resources you can use for assistance:

• Call 1-800-MEDICARE. You can call Medicare to learn about plan options in your area, confirm your current coverage, or change your coverage.
• Visit www.medicare.gov/find-a-plan. You can use this online tool to search for and compare plans.
• Call a Medicare Advantage Plan or a stand-alone Part D plan. By calling your plan you can learn about coverage and costs for the upcoming year, request a copy of the plan’s formulary, or enroll in the plan.

Fall Open Enrollment is a time to consider all of your health care options and needs. Even if you decide not change how you receive your Medicare benefits, it is a good idea to review your coverage and any changes that the plan may put in place for 2017.

– Marci

We are down to the last two weeks for Medicare Open Enrollment. If you are not satisfied with your current situation- now is the time to act.

There are all sorts of places that claim to be able to “help” but are sales agents. You can find a great deal of information at medicare.gov.  That is the official site.

Give information on your current coverage and the area in which you live and the best possibilities will be displayed for you. If you are looking at other sites- take note of the areas that Medicare sees as important. Use those same items to compare other plans.

You won’t get everything you need from medicare.gov. They do not tell you whether a plan has Silver Sneakers or other special coverages. Be sure to do a thorough review before making a decision.

For more personal help, below is information from ElderSource, our local Council on Aging:

From October 15 to December 7, seniors 60 years and older have the opportunity to review their Medicare insurance plans and make changes to their policies, if desired or necessary. What does this mean toElderSource?  Our SHINE volunteers (Serving Health Insurance Needs of Elders) will be making presentations, counseling seniors and caregivers on how to best utilize their Medicare benefits.

Dear Marci,

Can I switch from a Medicare Advantage Plan to Original Medicare and a Medigap during Fall Open Enrollment?

-Harold (Bloomington, IL)

Dear Harold,

This is a question that comes up a lot at this time of year. In general, you can make any changes you would like during Fall Open Enrollment. You can switch from Original Medicare to a Medicare Advantage Plan, eneroll in a new Part D plan, change your Medicare Advantage Plan, or switch from a Medicare Advantage Plan to Original Medicare.

However, it is important to keep in mind that depending on where you live, you may be limited in your ability to buy a Medigap policy. This is because, while the federal government sets general guidelines for Medigap enrollment, states can have additional rules. Some states also choose to be more flexible than the federal government in terms of who can buy a Medigap and when.

Under federal rules, there are only certain protected times when an insurance company is required to sell you a Medigap policy. During these times, the insurance company must offer you the best possible rate, regardless of your health status.

1. During your Open Enrollment Period. The Medigap Open Enrollment Period spans for six months starting with the first month you are enrolled in part B. What this means is that after your Open Enrollment Period ends, you may not be able to buy a Medigap, or you may have to pay more because of health conditions. This is important to point out, as people signing up for Medicare for the first time may have to make a decision that will last their entire lifetime. In some cases, an individual who does not buy a Medigap during their Open Enrollment Period may not be able to buy one in the future.
2. While you have a guaranteed issue right. If you do not enroll in a Medigap during your Open Enrollment Period, or you later disenroll, certain events can trigger a guaranteed issue right. During this time, you also have protections to buy a Medigap policy, and insurance companies cannot deny you coverage based on your health status. For example, if you are age 65 or older, you have a guaranteed issue right within 63 days of when you lose or end certain kinds of health coverage. This coverage change could occur if you had group health insurance that paid after Medicare, and you lost it through no fault of your own. When you have a guaranteed issue right, companies must sell you a policy at the best available rate, regardless of your health status, and cannot refuse to sell you a policy.

You may run into problems if you try to buy a Medigap policy outside of your protected enrollment periods. Companies can refuse to sell you a policy or may only let you buy one if you meet certain medical requirements. If an insurance company does agree to sell you a policy, you will probably need to pay a higher monthly premium, and you may need to wait six months before the Medigap will cover pre-existing conditions.

Some states, like New York, allow beneficiaries to buy a Medigap at any time without meeting medical standards. Other states, however, do not have the same policies. In Illinois, where you live, there may not be additional protections beyond federal ones. The Open Enrollment Period only lasts for the first six months that you have Part B. Because you are no longer in your Medigap Open Enrollment Period, you may have some trouble if you want to buy a Medigap.

The best thing to do if you have any Medigap questions is to contact your State Health Insurance Assistance Program (SHIP) or your State Department of health. They can provide you with specific information about the regulations in your state.

– Marci

Medicare’s Open Enrollment Period Takes Place October 15 through December 7

The Medicare Rights Center urges everyone with Medicare who is enrolled in a private Medicare Advantage health plan or Part D prescription drug plan to use the Fall Open Enrollment Period to review their coverage. Because plans make changes to their benefit packages every year, even people who are currently satisfied with their plan should review their coverage. Those enrolled in Original Medicare can also decide to switch to a private plan or choose a new stand-alone drug plan at this time.

During the Fall Open Enrollment Period, Medicare beneficiaries have the right to make as many changes as they need, and the last change they make on or before December 7, 2015 will go into effect on January 1, 2016. To review their coverage options, beneficiaries can use the Medicare Plan Finder tool at www.medicare.gov or call 1-800-MEDICARE. Plan Finder makes available important information about health and prescription drug plans, including information about pharmacy networks, cost sharing, and coverage rules.

Medicare Rights recommends that beneficiaries call their current plan or any plan that they are considering to confirm the information they pull from Plan Finder. As a best practice, beneficiaries should keep a record of their conversations with plan representatives. Additionally, Medicare Rights recommends enrolling in a plan by calling 1-800-MEDICARE rather than the plan itself.

For a list of questions to ask before joining a Medicare Advantage or Part D plan, visit Medicare Interactive. Beneficiaries who prefer to speak with a counselor can call the Medicare Rights Center’s toll-free helpline at 800-333-4114. Counselors are available Monday through Friday.

State Health Insurance Assistance Programs (SHIPs) also provide free counseling services. To find your local SHIP, go to www.shiptacenter.org/.