Q. What is the Annual Notice of Change? A. Each year in September Medicare Advantage plans and Prescription Drug plans are required to send each insured member an Annual Notice of Change. This document will go over the changes being made to your plan for the coming year. Everyone should receive their notice before October 1st. Seeing the changes being made to your plan allows you to make an informed decision about your coverage for the coming year. Although the booklet is fairly thick, most of the changes will be summarized in the first part of the booklet.
Q. What are the Annual Enrollment Period (AEP) and Medicare Annual Disenrollment Period (MADP)? A. AEP is the time of year when anyone is able to change or enroll in a Medicare Advantage Plan or a Prescription Drug plan. The AEP is from October 15th through December 7th of each year. Any changes made during this time will take effect on January 1st of the following year. The MADP is from January 1st through February 14th. This is a time period when someone can disenroll from a Medicare Advantage plan and go back to original Medicare and select a stand-alone Prescription Drug plan. You are able to change Medicare Supplement plans at any time through the year. You don’t have to wait for AEP to change or enroll. Medicare must be your primary insurance.
Q. What are my coverage options with Medicare? A. Although Medicare is good coverage, you still must pay certain costs, such as the Part A deductible and co-pay amounts as well as the Part B deductibles and co-insurance. There is no limit to what you may be responsible to pay. However, solutions are available to you. You may enroll in a Medicare Supplement plan (secondary to Medicare) and a Part D Prescription plan. Or, you may enroll in a Medicare Advantage plan that includes prescription drug coverage. (Medicare Advantage Plans are under contract with Medicare and becomes your primary insurance.)
Q. What should I look for in a Medicare Advantage Plan? A. It is essential to look at your maximum out of pocket exposure. This represents the worst case scenario of what you may be responsible for financially. You should:
Make sure your providers are in the network. If you go out of network your cost will be higher.
Verify that your prescriptions are covered and at what cost. Not all plan formularies are the same.
Determine if there is coverage for dental and eye glasses.
Ask yourself if you need coverage when you are living in another state.
These items and others are all important to consider. Reviewing your needs with a Medicare professional will help you determine which options are best for you.
Q.Does Medicare cover dental and vision? A. Original Medicare is designed to cover “medically necessary” care. Dental and vision care are not considered medically necessary. Thus, services such as teeth cleaning, dental exams, x-rays, vision exams, frames and lenses are not covered.
Some Medicare Advantage plans, which are offered through private insurance companies, include dental and vision coverage as basic benefits; other plans may charge an additional premium. Available plans vary based on where you live. It’s important to review your options with a Medicare professional to find the plan that best fits your needs.
Q.What happens now that I’ve enrolled in a Medicare Advantage plan? A. You should receive a “welcome kit” and your insurance card within 2-3 weeks of enrolling. The kit contains a detailed description of benefits under your plan, known as your Evidence of Coverage. If you chose to pay the premium through a deduction from your Social Security check, you may have to pay the first month’s premium until Social Security adds the automatic deduction.
If you changed from a Medicare Supplement to a Medicare Advantage plan, you need to cancel your supplement policy once you receive confirmation that the new plan is approved. Your current prescription drug coverage will automatically be cancelled. If you moved from one Medicare Advantage plan to another, the old plan will automatically be cancelled.
Check with a Medicare professional to learn more about the benefits available to you.
Q.I have a Medicare Supplement and Part D drug plan and the costs keep going up—what can I do? A. One option is to change to a Medicare Advantage plan, but your annual healthcare costs should be considered. Reviewing your needs with a Medicare professional will help you determine which options are best for you.
If you change to an Advantage plan and find you don’t like it, under certain circumstances, you can choose to change back to a Medicare Supplement without answering health questions for up to one year. With some companies, this guaranteed issue period is two years.
At the Messmore Agency, consultations are always free, friendly, and no-obligation.
Q.Am I responsible for the amount above what Medicare approves? A. The answer is no.
If a doctor agrees to accept Medicare in Ohio they agree to accept what Medicare assigns as the value for that procedure as payment in full.
Example— If a provider charges $1,100 for a CT scan and the Medicare approved amount is $400, the 20% that you are responsible to pay is based on the $400 figure. This leave you with an $80 co-insurance. The amount above the approved amount ($700) is referred to as the part B excess. In Ohio the provider is not allowed to collect anything above what Medicare approves. In some states a provider can bill up to 15% of the excess which becomes your responsibility. Check with a Medicare profession to determine the best coverage for you needs.
Q.What happens if I miss the enrollment deadline of December 7th? A. If you want to change your Medicare Advantage or Part D Prescription coverage, you must do so by the end of the Annual Enrollment Period (AEP), which is December 7th. Unless you qualify for a Special Election Period (SEP), you will have to wait until next year’s AEP. SEP allows you to enroll in or change plans at other times throughout the year. Some qualifying events include:
Qualifying for “Extra Help” paying for prescriptions (enroll any time)
Moving from your plan’s service area (enroll within 2-3 months from when it is reported)
Losing employer group coverage (enroll within a 2 months window)
Having Medicare and Medicaid (enroll any time)
These are just a few examples. However, purchasing a Medicare Supplement can happen at any time. Discussing your situation with a Medicare professional will ensure you get the best coverage for your needs.
Q.When can I change my Insurance Plan? A. For most folks, this is done during the annual Open Enrollment Period (OEP) from October 15th through December 7th. Any changes you make during this period take effect January 1st of the following year. If you qualify for a Special Election Period (SEP) you can change plans at any time throughout the year. A few common SEPs include: getting “Extra Help” with your prescriptions; having both Medicare and Medicaid; or moving from your current plan’s service area.
Q.I’ve heard about an “extra help” program to pay for my prescriptions. What is it and do I qualify? A. The “extra help” program is offered through Social Security. The basic income and resources* guidelines to qualify are: Single Married (living together) Annual Income $18,090 $24,360 Resources* $13,820 $27,600
*Resources are items easily converted to cash (CDs, IRAs, and Mutual Funds, for example). Your primary home and car are not considered resources. If you think you qualify, you can apply for extra help from Social Security in one of three ways:
By Phone—1-800-772-1213 (TTY 1-800-325-0778)
In person—at the Social Security office in your county.
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