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It’s That Time of the Year‚ÄîMedicare Open Enrollment

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This week’s guest blog is provided by Charles Clarkson, Esq. This article, originally posted in issue #21 of the New Jersey Senior Medicare Patrol (SMP) newsletter¬†Advocate, will cover Medicare Open Enrollment, your options, and information about Medicare scams.

By Charles Clarkson, Esq.

Jewish Family Services of Middlesex County

Project Director, Senior Medicare Patrol of New Jersey

 

 

Every year between October 15 and December 7, a period known as “Open Enrollment,” Medicare beneficiaries can make changes in their Medicare coverage. The Senior Medicare Patrol of New Jersey (SMP), a Federally funded program of the U.S. Administration for Community Living, believes that if you know your options you can avoid being scammed and make the right choices, giving you the best coverage at the least cost.

 

Why make a change?  Whether you have Original Medicare (Part A and/or B), Part D (prescription drug plan), or a Part C (Medicare Advantage Plan,) your plan can change. Premiums, deductibles  and coverages can all change.  Even if they remain the same, your health or finances may have changed. SMP encourages all beneficiaries to re-visit their coverage and decide whether or not to change during Open Enrollment.

Beneficiaries have these choices:

  1. If you are enrolled in Original Medicare, you can change to 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.
  1. If you are in Original Medicare with a Part D plan, you can stay in Original Medicare and switch your Part D plan. Medicare has a Plan Finder on Medicare.gov which allows beneficiaries to compare plans for next year. The new Part D plans should be announced in late September or early October.
  1. 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 in Part D. 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 won’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 2019 beneficiaries in New Jersey can expect to choose from a number of PDPs.

 

Compare plans each year.

Beneficiaries should remember that PDPs 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 Medicare beneficiaries is the State Health Insurance Assistance Program (known as SHIP), telephone 1-800-792-8820. SHIP is federally funded and can provide beneficiaries with unbiased advice.  Call SHIP to make an appointment with a counselor. You do not need to use a broker or agent who may not be looking out for your best interest. Brokers and agents are usually being paid to enroll you in certain plans. Beneficiaries can also call the Senior Medicare Patrol of New Jersey at 732-777-1940.

 

Medicare Open Enrollment can also be a time of fraudulent schemes that can cost you money. The SMP wants you to be on the alert for scams. A word of advice:

When you realize that a scammer is calling. Just hang up. Do not be polite and just hang up. Also, let your answering machine do all the work. Never answer any call unless you recognize the number. If no message is left, you know the call is probably a scam or an unwanted solicitation. For any questions about Medicare and to report any Medicare scams, call the Senior Medicare Patrol of New Jersey at 732-777-1940.

Medicare Open Enrollment Period

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Medicare Open Enrollment

Medicare Open Enrollment is October 15, 2011 – December 7, 2011

Did you know new prescription drug and health plan coverage choices are offered every year? Every fall, all people with Medicare should review their current coverage.

During the Fall Open Enrollment you can change how you receive your health coverage and add, change or drop drug coverage. You can make as many changes as you want. Changes made during the Fall Open Enrollment take effect January 1, 2012. If you don’t want to make any changes you don’t need to do anything, your current coverage will stay the same.

What you can do:

  • 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‚Äôt 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‚Äôt 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 Disenrollment Period 2012: January 1, 2012 – February 14, 2012

During the Medicare Advantage Disenrollment Period (MADP) you can switch from a Medicare private health plan (also known as a Medicare Advantage plan) to Original Medicare. Regardless of whether the Medicare private health plan had drug coverage, you can join a stand-alone prescription drug plan, but you are not required to. For example if you have a Medicare Advantage Plan with drug coverage you can change to Original Medicare and a prescription drug plan or Original Medicare and no drug plan.  Changes made during the MADP go into effect the first day of the following month.

What you can do:

  • If you are in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare.
  • If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
    Note: During this period, you can’t do the following:
  • Switch from Original Medicare to a 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 Account Plan.

Choosing Medicare coverage can be confusing, but understanding the different parts of Medicare and your Medicare coverage choices can help.  You can use the Medicare Plan Finder https://www.medicare.gov/find-a-plan/questions/home.aspx to help you make a decision about the best plans for you.

 If you would like assistance with this process please contact a State Health Insurance Assistance Program (SHIP). To find a SHIP program in your area visit: http://www.state.nj.us/health/senior/sashipsite.shtml

Medicare Myths

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According to a study done by Prudential in 2009 37% of people think that Medicare will cover their long-term care costs. This is false. Medicare does not pay for long-term care. Medicare is also not free, there is a monthly premium associated with Medicare Part B.

Here are the facts about Medicare.  Medicare is for people 65 years of age or older (or people with disabilities). Medicare Part A (also known as hospital insurance) covers hospital stays, short-term skilled nursing care, hospice and home care services. Medicare Part A does not have a premium (if you or your spouse have paid Medicare taxes).

Medicare Part B (also known as Medical Insurance) does have a premium that is paid monthly. Part B covers doctor’s services, outpatient care, home care services and some preventive services.

Back to long-term care, what Medicare does cover, under Part A is Skilled Nursing Facility care on a short term basis. There are several guidelines for that coverage that you should also be aware of. After a 3 day minimum hospital stay, you are eligible under Medicare Part A for a short-term stay in a Skilled Nursing Facility, for rehab and nursing services. The goal is to get the individual strong enough to return home.

What Medicare Part A covers is up to 100 days of this skilled care at a nursing facility. You may not need the entire 100 days. The staff at the nursing facility will estimate the amount of time needed to rehabilitate the patient based on Medicare guidelines for Physical, Occupational and Speech Therapies, as well as, medical interventions given by nursing staff. It is also important to note that there is a benefit period associated with your 100 days of Skilled Nursing Care. This means that if you use your 100 days, you will not be eligible for another 100 days (even if you have another 3 day hospital stay) for 60 days. During those 60 days you must not have received any Skilled Nursing services. So, keep this in mind when planning your discharge from the Skilled Nursing Facility. Another thing to keep in mind is that after 20 days in the Skilled Nursing Facility you are responsible for a 20% co-pay per day. The co-pay is based on the per day rate approved by Medicare. If you have a supplemental or Medi-Gap policy, this may cover your co-pay, call your insurance plan to verify this. It is very important when being admitted to a Skilled Nursing Facility to provide all of your insurance information, including you supplemental coverage.

In closing, Medicare covers many inpatient and outpatient services through Part A & Part B, but they do not cover long term care, also referred to at custodial care. It is important to know what Medicare covers when thinking of your short term and long term health needs.

For more information visit:

 www.medicare.gov Рto view the 2011 Medicare and You Handbook,

or call 1-800-633-4227 to request a Handbook.

http://www.medicare.gov/publications/pubs/pdf/10153.pdf – for a handbook on Medicare Coverage of Skilled Nursing Facilities