Medicare Open Enrollment Starts October 15

October 24, 2013 - By the NCPC

Author: Valerie Michel Buck

It’s that time of year again to consider making changes to your existing Medicare Plans.  Medicare’s Open Enrollment period gives all beneficiaries the opportunity to make changes to their plans as their lives and needs change.

Why is the enrollment period so Important?

Medicare policies and coverage change periodically. It’s important to keep up on what these changes are, what they mean and how they affect you.  Whether you are happy with your Medicare plan, the changes made to your plan may alter that. For any pending changes, a beneficiary should receive an Annual Notice of Change (ANOC). Most people will receive this document in the fall. Take time to review these changes and be aware of which plans they effect. Take special notice of the benefits and disadvantages that these changes create. Also please note when these changes take effect to ensure your coverage needs are well, covered.

Recurring Enrollment Periods

October 15th to December 7th the following can be made:

• Change from Original Medicare to a Medicare Advantage Plan (Part C).
• Change from a Medicare Advantage Plan (Part C) back to Original Medicare.
• Switch from one Medicare Advantage Plan (Part C) to another Medicare Advantage Plan (Part C)
• Switch from a Medicare Advantage Plan (Part C) that doesn’t offer drug coverage to a Medicare Advantage Plan (Part C) that offers drug coverage.
• Join a Medicare Prescription Drug Plan.
• Switch from one Medicare Prescription Drug Plan (Part D) to another Medicare Prescription Drug Plan (Part D).
• Drop your Medicare Prescription Drug coverage (Part D) completely.

January 1st to February 14th the following changes can be made: 

• Change Medicare Advantage Plans to Original Medicare. Changes will begin the first day of the following month.
• If you switch to Original Medicare during this period, you will have until February 14th to also join a Medicare Prescription Drug Plan to add drug coverage. Changes will begin the first day of the following month after the plan gets your enrollment form.

What you CANNOT do during this period:

• Switch from Original Medicare to Medicare Advantage Plan.
• Switch from one Medicare Advantage Plan to another.
• Switch from one Medicare Prescription Drug Plan to another.
• Join, switch or drop a Medicare Medical Savings.

NEW TO MEDICARE

What is Medicare?

As you may already know Medicare is our country's health insurance program for people 65 and older. Certain people younger than age 65 can qualify for Medicare including those who have disabilities, permanent kidney failure or Lou Gehrig's Disease. This program can help with the cost of health care, but it does not cover all medical expenses nor the cost of most long-term care. There is a Medicare Supplement policy called Medigap, which can be provided through private insurance companies to cover some of the costs that Medicare does not cover.

Medicare is financed by a portion of payroll taxes paid by workers and their employers, it is also financed in part by monthly premiums deducted from Social Security checks.

The agency in charge of Medicare is called The Centers for Medicare & Medicaid Services, you can apply for Medicare at their offices or at any Social Security Office.

Medicare Part A & B

Medicare Part A, also known as Hospital Insurance, helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health and hospice care. Medicare Part B, also known as Medical Insurance, helps pay for doctors’ services and many other medical services and supplies that are not covered by Medicare Part A. 

Medicare Part C & D

Medicare Part C, also known as Medicare Advantage, allows you to choose to receive all of your health care services through a provider organization. Medicare Part D, also known as Prescription Drug Coverage, is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare.  If you want Medicare Part D, you have to opt in by filling out a form and enrolling in an approved plan.

Initial Enrollment Periods.

Newly Eligible for Medicare because you turn 65.

You can: Sign up for a Medicare Advantage Plan (Part C) (with or without prescription drug coverage) or a Medicare Prescription Drug Plan (Part D).  
This can be done during the 7 month period that starts 3 months before the month you turn 65 (includes the month you turn 65) and ends 3 months after the month you turn 65.

You’re newly eligible for Medicare because you’re disabled and under 65.

You can: Sign up for a Medicare Advantage Plan (Part C) (with or without prescription drug coverage) or a Medicare Prescription Drug Plan (Part D).
Starting 21 months after you get Social Security or Railroad Retirement Board Benefits. Your Medicare coverage begins 24 months after you get Social Security or Railroad Retirement Board disability benefits. Your chance to sign up lasts through the 27th month after you get Social Security or Railroad Retirement Board Benefits.

You’re already eligible for Medicare because of a disability, and you turn 65.

You can: Sign up for a Medicare Advantage Plan (Part C) (with or without prescription drug coverage) or a Medicare Prescription Drug Plan (Part D); or Switch from your current Medicare Advantage Plan (Part C) or Medicare Prescription Drug Plan (Part D) to another plan; or Drop a Medicare Advantage Plan (Part C) or Medicare Prescription Drug Plan (Part D) completely.

This can be done during the 7 month period that starts 3 months before the month you turn 65 (includes the month you turn 65) and ends 3 months after the month you turn 65.

If you sign up for a Medicare Advantage Plan (Part C) during this time, you can drop that plan at any time during the next 12 months and go back to Original Medicare.

You don’t have Medicare Part A Coverage, and you enroll in Medicare Part B during the Part B General Enrollment Period (January 1- March 31).

You can: Sign up for a Medicare Prescription Drug Plan (Part D).
This can be done between April 1st - June 30th.

You have Medicare Part A Coverage, and you enroll in Medicare Part B during the Part B General Enrollment Period (January 1- March 31).

You can: Sign up for a Medicare Advantage Plan (Part C) (with or without prescription drug coverage) Medicare Prescription Drug Plan (Part D).

This can be done between April 1st – June 30th.

Qualifying for Medicare

If you are unsure whether you qualify for Medicare you can click here to learn the requirements for each Part in this brochure starting on the bottom of page 5.

Medicare and Medicaid

Most people don’t know the difference between the two programs. Medicaid is state run and provides hospital and medical coverage for people with low income and few to no resources. Each state has different criteria for who is eligible and what is covered under Medicaid.  People may qualify for both Medicare and Medicaid. For more information about Medicaid, contact your local social services or welfare offices.

For More Information

You can contact a Member of the National Care Planning Council to help you through this confusing process. Visit the following links to find professionals in your state who can help with Medicaid / Medi-Cal Planning or selecting Medicare Supplements, Advantage, or Drug Plans.

In additional you may also call The Centers for Medicare & Medicaid Services at their toll-free number 1-800-MEDICARE (1-800-633-4227) to get a Medicare Guide (Publication No. CMS-0217). For individuals who are deaf or hard of hearing, you may call TTY 1-877-486-2048, or visit medicare.gov/publications.