It’s that time again! Each year, you have a chance to make changes to your Medicare Advantage (Part C) or Medicare prescription drug coverage (Part D) for the following year.
Open enrollment for Medicare started October 15 and continues through December 7. The changes that you make during this enrollment period will take effect on January 1, 2015. Medicare is a U.S. federal program that provides health insurance for those 65 years old and older, and some people under 65 with certain disabilities. It is the largest health insurance program in the U.S.
What you can do during this enrollment period:
- Change from Original Medicare to a Medicare Advantage Plan.
- Change from a Medicare Advantage Plan back to Original Medicare.
- Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
- Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
- Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
- Join a Medicare Prescription Drug Plan.
- Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
- Drop your Medicare prescription drug coverage completely.
Medicare Advantage Plan (Part C)
Generally referred to as Medicare Part C, Medicare Advantage Plans are different ways of getting the benefits offered by Parts A and B and Medicare Supplemental Coverage. The plans have contracts with Medicare to provide insurance coverage. The plans may apply premiums, deductibles and co-pays. Some also include extra benefits like dental and vision screenings.
Medicare Part D (or Prescription Drug Plan)
Part D, Medicare’s Prescription Drug Plan, helps pay for medicine. To join, you may choose from numerous drug plans, all of which are approved by Medicare but administered by private companies. Each plan has a different monthly premium. A crucial part of deciding which drug plan to join involves knowing which prescription drugs are covered by the different plans. You will normally pay a co-pay when you pick up your medicine. Medicare Part A and Part B are considered “Original Medicare.” These two form the basic Medicare coverage. Most people with Original Medicare also join Part D.
According to the Medicare Rights Center, it is important when reviewing your options to always read the fine print. You may be attracted to low-cost drug plans or Medicare Advantage plans, but depending on your health status and the plan’s rules and restrictions, you may discover that the low-cost plan will actually cost you more than a plan with a higher premium.
To help you sort out which Medicare Advantage plans might save you money while giving you the best benefits, the Medicare Rights Center has developed a list of questions you should ask before enrolling in a plan. Here are some of the key items from their list:
- Will I be able to use my doctors? Are they in the plan’s network and are they taking new patients who have this plan?
- Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan’s network?
- How much is my monthly premium?
- How much will it cost to see my primary care physician? A specialist?
- Are my prescription drugs on the plan’s formulary (list of covered drugs)?
- Does the plan require that I get “prior authorization” before my prescription will be covered, or impose other restrictions (like limiting the quantity or requiring that I try a cheaper medication before it will cover a more expensive one)?
- How much will I have to pay out of pocket before coverage starts (what is the deductible)?
- How much will I pay for brand-name drugs? How much for generic drugs?
- What service area does the plan cover?
- What kind of coverage do I get if I travel outside of the service area?
If you or your loved ones have questions about Medicare, Oasis can help! Kathleen Stice, Oasis Insurance Counseling Coordinator, works with the CLAIM (MO) and SHIP (IL) programs located in Oasis offices at Barnes-Jewish Hospital, Barnes-Jewish West County, Christian Hospital and Alton Memorial Hospital. The CLAIM and SHIP programs offer free and private help with Medicare questions. We have knowledgeable, state-certified Oasis volunteer insurance counselors providing free, unbiased counseling to individuals with first-time Medicare enrollment, claims assistance and plan changes.
A Little Bit More about the Health Insurance Marketplace…
A number of people have called and asked about participating in the Health Insurance Marketplace provided by the Affordable Care Act. If you are eligible for Medicare or currently enrolled in Medicare, the Health Insurance Marketplace is not for you and you don’t need to do anything to keep your current Medicare coverage.
If you are uninsured and do not qualify for programs such as employer’s insurance or government sponsored programs such as Medicare, Medicaid or VA benefits, you can explore your health insurance options in the Health Insurance Marketplace. The one exception to this is if you are not eligible for premium-free Part A (hospital insurance) under Medicare. Most people don’t pay for Part A; however, if you are required to pay premium for Part A, filling out the Health Insurance Marketplace application at https://www.healthcare.gov to check out your options may be worthwhile.
The Open Enrollment period for 2015 Health Insurance Marketplace coverage is November 15, 2014 to February 15, 2015. If you haven’t enrolled in coverage by then, you generally can’t buy Marketplace health coverage for 2015 until the next Open Enrollment period for coverage the following year.
If you’re enrolled in a 2014 Marketplace plan, your benefit year ends December 31, 2014. To continue health coverage in 2015, you can renew your current health plan or choose a new health plan through the Marketplace during the 2015 Open Enrollment period.
If you don’t have health coverage during 2015, you may have to pay a fee. The fee in 2015 is higher than it was in 2014 — 2% of your income or $325 per adult/$162.50 per child, whichever is more.
To be sure you avoid the federal penalty and start receiving healthcare coverage in 2014, enroll in the Health Insurance Marketplace today.
Remember, if you are eligible for Medicare or Medicaid, you are not generally eligible to buy health coverage on the Health Insurance Marketplace. But you may have friends and family who do not have health insurance and need to find out if they are eligible on the Marketplace for affordable health insurance.
If you have general questions about Medicare or the Health Insurance Marketplace, contact the following resources:
State Health Insurance Assistance Program (SHIP) office
CLAIM (Missouri): (800) 390-3330
SHIP (Illinois): (800) 548-9034
To schedule a one-on-one appointment with one of our CLAIM or SHIP certified counselors, call (314) 362-7587 (Missouri) or 1-800-392-0936 (Illinois).
Health Insurance Marketplace Hotline: (800) 318-2596 (available 24/7 answer line)
Oasis Marketplace Insurance Counseling: (314) 653-4345