It’s Medicare Open Enrollment Time Again
It’s Medicare Open Enrollment time again and that means time for another refresher on what that expression means. The first thing you need to know, by the way, is not to get Medicare Open Enrollment confused with Open Enrollment for the Healthcare Marketplace. Medicare Open Enrollment is for those age 65 and older or disabled under Social Security Disability for two years who want to enroll in or change Medicare Advantage or Medicare D prescription plans. The Healthcare Marketplace, on the other hand, is basically for everyone else including younger people and those who are not disabled but do not have health insurance either through an employer or otherwise. The dates for enrolling for the two “Open Enrollments” are different.
Here are FAQ’s for what you need to know about Medicare Open Enrollment.
1. When is Medicare Open Enrollment for 2017 Coverage? Medicare Open Enrollment for 2017 runs from October 15, 2016 to December 7, 2016. If you are just becoming eligible for Medicare (such as just turning age 65), you can sign up for Medicare as soon as you become eligible regardless of the month. But each year, if you are in a Medicare Advantage plan or Medicare D prescription drug plan, you can change your enrollment to another Medicare Advantage or Medicare D plan between October 15 to December 7 effective the following year.
2. Do I Need To Do Anything During Open Enrollment? Not necessarily. If you have coverage and are content with what you have you might just ride out the period until next year. However, Medicare Open Enrollment gives the opportunity to change. Health insurers can make changes in cost, coverage and what health care providers and pharmacies are in their network. These might make a difference to you. Check out your plan. Check to see whether your medications are still covered and are considered in the same tier. Check to see the providers if you have a plan that limits providers, and look to see whether your doctor, hospital and pharmacy are still covered.
3. I am on a Medicare Supplement Plan. Do I need to check out Open Enrollment? Open enrollment relates to Medicare Advantage plans and Medicare D prescription plans. If you have a Medicare Supplement Plan, the Open Enrollment period does not apply to you unless you want to sign up for Medicare Advantage or you have a Medicare D prescription plan and want to change.
4. Are there any other limitations involved in changing plans? When you are first enrolling in Medicare, you have the right and the ability to choose to enroll for a Medicare Supplement plan without regard to your health. Medicare Supplement plans are typically more expensive. Sometimes, to save money, enrollees might initially sign up for a Medicare Advantage plan. If they do and later experience poor health they can be denied the ability to switch to a Medicare Supplement for better coverage. If you are already in a Medicare Advantage plan, you can switch to another Medicare Advantage plan without medical underwriting and your health is not a consideration in changing plans during the Open Enrollment period.
5. There is a wide diversity of coverage among Medicare Advantage (HMO, PPO, PFFS) plans. Not all Medicare Advantage plans are the same. Also, they are typically divided into categories such as HMO, PPO, PFFS. The Medicare Advantage HMO might or might not limit your providers. It is less likely to be “portable” that is to provide coverage if you move to another coverage area, another state or another part of the country. PPO’s typically allow more flexibility and are more likely to be transportable. If you have a choice between an HMO and a PPO, the PPO more often is the better choice. PFFS plans are not necessarily recognized by all medical providers who take Medicare.
6. It is important to know how prescription drugs and medical coverage work and the differences between Medicare Supplement and Medicare Advantage. Medicare Supplement plans do not themselves have prescription drug coverage but rather are often marketed with a separate PDP or prescription drug plan (look for PDP or Rx on the card). Medicare Advantage plans usually come with prescription coverage.
If you are confused, get help. The Chester County APPRISE program staffed by volunteers, is excellent. It can be contacted at 610-344-6035.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.