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By Charles Clarkson, Esq.
Project Director, Senior Medicare Patrol of New Jersey

Every year Medicare beneficiaries have a choice. Between October 15 and December 7, a period known as “Open Enrollment,” Medicare beneficiaries can switch their current Medicare coverage.

Why make a change? If you are in Original Medicare (Medicare Part A and/or B), and have a prescription drug plan, Medicare Part D, or if you are in a Medicare Advantage Plan, Medicare Part C, your plan can change how much it costs and what it covers. Even if they remain the same, your health or finances may have changed. The Senior Medicare Patrol of New Jersey encourages all beneficiaries to re-visit their coverage and decide whether or not to make any changes during Open Enrollment. The choices beneficiaries have are as follows:

1. If you are enrolled in Original Medicare, you can join a Medicare Advantage plan with or without drug coverage. These plans are private companies approved by Medicare and give you the services of Original Medicare. If you join a Medicare Advantage plan, you do not need (and are not permitted) to have a Medicare supplement insurance plan (also known as a Medigap policy) and if your Medicare Advantage plan has drug coverage, you will not need a Part D plan.

2. If you are in a Medicare Advantage Plan, you can switch to another Medicare Advantage plan or drop your Medicare Advantage Plan. If you decide to drop a plan and not switch to another plan, you will be enrolled in Original Medicare. You should then consider enrolling in a Medicare supplement insurance plan to cover the costs that Original Medicare does not pay for and enroll in a Part D plan for drug coverage.

3. If you are in Original Medicare with a Part D plan, you can stay in Original Medicare and switch your Part D plan.

4. If you are in Original Medicare and do not have a Part D plan, you can enroll in a Part D plan. If you join a Part D plan because you did not do so when you were first eligible for Part D and you did not have other coverage that was, on average, at least as good as standard Medicare drug coverage (known as creditable coverage), your premium cost will be penalized 1% for every month that you did not enroll. You will have to pay this penalty for as long as you have a drug plan. The penalty is based on the national average of monthly premiums multiplied by the number of months you are without coverage and this amount can increase every year. If you qualify for extra help (low income subsidy), you don’t be charged a penalty.

Why change Part D plans? Beneficiaries may want to change Part D prescription drug plans (PDPs) for a number of reasons: (i) the PDP has notified the beneficiary that it plans to drop one or more of their drugs from their formulary (list of available medications); (ii) the beneficiary is reaching the coverage gap (donut hole) sooner than anticipated and may want to purchase a PDP with coverage through the coverage gap, if one is available; (iii) the PDP has notified the beneficiary that it will no longer participate in the Medicare Part D program; (iv) the PDP will increase its premium or co-pays higher than the beneficiary wants to pay and a less expensive plan may be available and (v) a beneficiary is not happy with the PDP’s quality of service or the plan has received low rankings for a number of years. For 2016 beneficiaries in New Jersey they can expect to choose from a number of PDPs. A list of plans can be found online at the State Health Insurance Assistance Program (SHIP) website:

More information can also be found in the 2016 Medicare & You booklet https://www.medicare.gov/Pubs/pdf/10050.pdf

Compare plans each year. Beneficiaries should remember that PDPs will change every year and it is recommended that beneficiaries compare plans to insure that they are in the plan that best suits their needs. When comparing plans, keep in mind to look at the “estimated annual drug costs,” i.e. what it will cost you out of pocket for the entire year, from January 1 through December 31 of each year. Plans can be compared at the Medicare web site: www.medicare.gov. If you do not have access to a computer, call Medicare at 1-800-Medicare to assist in researching and enrolling in a new plan. Medicare can enroll a beneficiary over the telephone. When you call, make sure you have a list of all your medications, including dosages. Another resource for beneficiaries on Medicare eligibility and enrollment is the State Health Insurance Assistance Program (SHIP) at 1-800-792-8820. SHIP counselors provide one-on-one counseling, free of charge. You can also call the Senior Medicare Patrol of New Jersey at 732-777-1940. In addition, remember that using generic drugs whenever possible will save you money and usually you can save even more money if you buy your medication by mail if your plan has a mail order option. Some plans will deliver tier 1 generic medications free of charge.