Medicare open enrollment starts today...

Medicare open enrollment is just around the corner Oct. 15 - Dec. 7. Whether you’re a person with Medicare, a caregiver, or professional helping clients to review their coverage options, we’ve got some helpful tips for you to keep in mind this season.

Tips for Consumers

1. Start early - Yes, open enrollment runs until Dec. 7. But the best time to start thinking about whether you want to change your drug or health coverage is now. If your circumstances have changed—for example, you’re taking different medications, or you’ve heard that your plan is changing—it’s important to have time to review all your options. And if you need personalized assistance, it’s easier to schedule an appointment now than if you wait until after Thanksgiving.

2. Pay attention to your mail - This is the time of year that you’ll start to get a lot of information.
Your Part D or Medicare Advantage plan sends out an Annual Notice of Coverage in September, which explains any changes happening to your plan and/or to your benefits in 2013.
If you get help paying for your Medicare, such as through the Medicare Part D Low Income Subsidy (Extra Help) or Medicare Savings Programs, you may receive mail from Social Security or Medicare asking you to verify your income or informing you of changes to your subsidy. You may also get a letter if your plan is ending service in your area, or has not met quality standards for three years. Save all of these letters, and have them on hand as you discuss your options with an SGIA (Strategic Growth Insurance Associates) counselor.

3. Review, review, review - Many people are happy with their current coverage, and would rather not check what other options are available to them. But this is a very important step, and can save you money. What should you look for? We like to remind people of the 4 Cs:

• Cost - How much have you spent in premiums, deductibles, and co-payments in 2012? How will these amounts change in 2013??
• Coverage - Does your plan cover all of the medications you believe you will need in 2013?? Do you want to get your health care and drug coverage through one single plan? If so, you should review your Medicare Advantage options.
• Convenience - To what extent will your plan restrict access to certain medications you need in 2013, such as through prior authorization or quantity limits? Can you use the plan at the pharmacy of your choice? Can you get your prescriptions through the mail if you prefer to?
• Customer service - Is your plan responsive when you have a question?

Decisions, decisions, it's that time of year again....

Navigating the Medicare maze is confusing enough, but the added pressure of the looming open enrollment deadline can be overwhelming. The following are 10 things you should know for enrolling in Medicare this year.

1. Open enrollment runs from October 15 to Dec 7, 2011

This window is the time that seniors can sign up for Medicare Advantage (Part C) or Medicare Prescription Drug Coverage (Part D) or they can make changes to an existing plan, move to a new one, change drug coverage benefits or dis-enroll.

2. There are two ways to get Original Medicare (Part A and Part B)

Choose Original Medicare on its own, with the option to add Medicare Part D prescription drug coverage. If you collect benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically get Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). There is a premium for Part B. If you don't want to keep Part B, you must follow the directions when you get your Medicare card, indicating you don't want it. Otherwise, you will be charged.

Or choose a Medicare Advantage (Medicare Part C) plan that bundles Original Medicare with extra benefits and may include prescription drug coverage in one plan. Medicare Advantage Plan is like an HMO or PPO. You may have to go to doctors within their service network or pay higher co-pays for going out of network.

3. Your share of the Medicare costs may be larger than you expect

Medicare, the traditional benefit provided by the government, doesn't cover all medical expenses. For example, approximately of 20% of physician fees are paid by the Medicare beneficiary. Seniors often find themselves paying out-of-pocket for many of their healthcare expenses.

4. Medicare Advantage Plans pick up where Medicare leaves off

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. This insurance provides your Part A, Part B and oftentimes, Part D coverage. You use a Medicare Advantage card for health care.

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

5. Timing matters

Timing matters when you're joining Medicare. When you turn 65 or otherwise become eligible for Original Medicare (Parts A and B), enrollment windows open. But some of these windows will close quickly. If you wait until later to sign up, you may have fewer choices, and you may pay more. During Open Enrollment Period, you can:
•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't 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't offer drug coverage.
•Join a Medicare Prescription Drug Plan.
•Switch from one Medicare Prescription Drug Plan to another.
•Drop your Medicare prescription drug coverage completely.

6. Know what you're paying

When you're deciding whether or not to add, change or drop plans, pay attention to what you're paying. Look at your total out-of-pocket healthcare expenses from last year. It's not just the premium, but check to see what may have changed with the deductible, co-pays, prescription drug costs.

7. Doing nothing is an option

If you don't make any changes during Medicare Open Enrollment, your existing plans will rollover at the end of the enrollment period with no changes and your existing coverage will remain in effect throughout 2012.

8. If you miss the deadline, there may still be hope

If you missed the deadline, you may have to wait until next year before you make changes, or you will pay penalties and higher premiums.

However, there is a second enrollment period from January 1 to February 14. During this time, you can:
•If you're 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.

9. Sometimes it's not so easy to "just switch back"

An insurance agent might say that "if you don't like the Medicare Advantage plan, you can just switch back." But it's not that easy. You can get stuck in a plan. You can only drop Medicare Advantage during certain time periods. In recent years, a new "disenrollment period" for Medicare Advantage plans is offered. From January 1 through February 14, a senior can disenroll if they are unhappy with the Medicare Advantage Plan they purchased. They can go back to regular Medicare coverage and, if they wish, pick up a prescription drug plan. (But beware: Medigap is different. Once you give up a Medigap plan, you might not be able to get it back.)

10. Get help if you need it

Don't go it alone. If you don't understand something, ask for help. For information on Medicare and/or personal assistance with signing up for Medicare Advantage Plans (Part C) or Medicare prescription drug coverage (Part D), including instructions on how to join, contact Medicare Marketplace or SGIA Retiree Support Center.