It’s Open Enrollment season for Medicare. This is the time to examine your benefits and make sure your plan is working for you.
Did you know that there is a free, unbiased service that can help people walk through the Medicare process?
The Centers for Medicare and Medicaid Services (CMS) helps fund and support a nationwide network of State Health Insurance Programs (SHIPs) that help beneficiaries understand their Medicare and Medicaid benefits, get answers to questions and help trouble shoot problems. These programs may go by different names in different states (Michigan’s program is called the Michigan Medicare Medicaid Assistance Program or MMAP), but they all offer a cadre of highly trained, certified, volunteer counselors that have been trained in health care benefits counseling. This includes Medicare, Medicaid and other Medicare insurance products. SHIP counselors are completely unbiased, are not connected with any insurance company and they are not licensed to sell insurance. Counselors are available year-round to guide and assist beneficiaries but are especially busy during the annual Medicare Part D Open Enrollment, which runs October 15 through December 7. Many SHIP programs offer special assistance to help people review and assess their Medicare Part D choices during this enrollment period.
Reviewing Your Plan Annually is Important
The Open Enrollment Period is the one time of year most Medicare beneficiaries can make changes to their Medicare Part D prescription benefits. During Open Enrollment you can:
• Switch Medicare Part D Prescription Drug plans.
• Change from Original Medicare to a Medicare Advantage Plan
• Switch from one Medicare Advantage Plan to another Medicare Advantage Plan
Any changes in coverage that you make will take effect on January 1, 2019.
I recommend that everyone review their plan options and choices once a year. Even if you’ve been happy with your current plan it is important to check that all your medications are still covered and that the price point is still affordable for you.
Be sure to understand that your health needs and how you like to access services are unique to you. You do not need to get the same policy as your friend or your spouse, even if they claim theirs is “the best!” Everyone is different. For example, if you only take one medication and your friend takes 5, they may have the best policy for them. You may end up spending significantly more money than necessary if you choose the same plan base on their recommendation. A SHIP counselor can compare plans with you to help make that determination.
How Much Does Medicare Cost?
Medicare can be quite expensive depending on the plans chosen. Each plan is different. Premiums, deductibles and co-pays vary; the medications you take might change from year to year, both in terms of what you take, and what is on the plan formulary; the policies and prices can change from year to year, and, if you have a Medicare Advantage (Part C) plan, the services may vary. Your local SHIP counselor can review all of this with you. And, if you are having difficulty paying for Medicare or your prescription drugs, SHIP counselors can also determine if you might qualify for assistance to help pay for any or all of your Medicare costs based on your income or assets, and they can also assist with the application process.
What Are My Medicare Options?
People who are new to Medicare can select Original Medicare, which is Part A for Hospitalization and Part B for outpatient services, or a Medicare Advantage Plan (Part C) which functions more like an HMO or PPO. Most Medicare Advantage plans cover prescription drugs. But, if you select Original Medicare you will most likely also need a Part D, prescription drug plan and a Medigap (or Supplemental Plan) to cover certain costs under Original Medicare.
When Can I Enroll?
There is a seven month period for people just turning 65 to enroll in Medicare (3 months before your 65th birthday, the month of your birthday, and 3 months after). Timely enrollment is essential as there are financial penalties for late enrollment that can follow you throughout your lifetime. For those who already have Medicare, Open Enrollment provides you with an opportunity to make changes to your plans.
If you want a Medigap policy you have a six month period starting the first day of the month you turn 65 or older and are enrolled in Part B to purchase a policy with a “guaranteed right of issue,” meaning that you cannot be medically underwritten. After that period costs may go up based on your age, health or medical conditions.
If you are still working, have a retirement health plan or are covered by your spouse’s health plan, you may not need to enroll in certain parts of Medicare. It is best to check with your employer Plan Administrator to get more specifics. This may prevent costly penalties or unnecessary duplication of coverage.
Prevention and Wellness Coverage
If you are new to Medicare, you are entitled to a comprehensive “Welcome to Medicare” visit during your first year and yearly preventive visits thereafter. Medicare also offers many preventive and wellness services such as vaccinations, mammograms, prostate cancer and obesity screenings, smoking cessation counseling and more. You are also entitled to a yearly “Wellness Visit” to develop or update your personal care plan. All of this is detailed the Medicare and You book that is mailed out every year to Medicare beneficiaries. Additionally, the phone number for your local SHIP will be listed on the back.
Protect Your Identity
You have probably heard that Medicare is issuing new cards this year. You may already have received yours. The new cards have removed the Social Security numbers. There is now a Unique Alpha-Numeric Medicare Number with no personal identifiers attached. Gender information and the signature line have also been removed. This is to provide protection against Identity Theft that has become all too common in our society. Medicare started issuing new cards in April of 2018 and the roll-out is set to continue until April of 2019. Don’t worry if you haven’t received your card yet. The old cards can be used until December 31, 2019. Your new cards will be mailed automatically to you, but you may not receive your card at the same time as your neighbors or friends. It is important to note that you don’t have to do anything to receive your card. Scammers are contacting people insisting that they give their Social Security numbers or other information to get their new cards. A good rule of thumb is to never give out personal information over the phone unless you are dealing with a trusted contact. And, anyone who asks you to send or do something to get your card is not a trusted contact.
How Can I Learn More?
There are many resources available to you to learn more about Medicare or to help you make decisions. As mentioned earlier, Medicare and You provides fairly comprehensive information on Medicare and the services it covers. The Centers for Medicare and Medicaid has a user-friendly web-site www.medicare.gov, which also provides good information.
And, your local SHIP program has certified volunteers who have been trained to provide personalized one-on-one counseling to Medicare beneficiaries. We can help you understand your health care options, compare or enroll in Medicare Prescription Drug Coverage, review your supplemental insurance needs, apply for additional assistance, identify and report fraud or scams, and more. To find your local SHIP, go to www.shiptacenter.org and type your state in the box or look on the back of your Medicare and You book. We are here to help.
Shari Wenokur Smith holds a Master’s in International Development from the American University in Washington, D.C., and a Master’s of Public Health from the University of Michigan. She also is a Certified Senior Advisor. She is currently the Regional Coordinator for the MMAP Program with the Area Agency on Aging 1-B in Southfield, Michigan, when she works with a team of 147 certified volunteers providing Medicare counseling throughout most of Southeast Michigan.