Medicare Open Enrollment Is Here

Here’s What You Need To Know

Michel Anne Whitney

Michel Anne Whitney

G. Joseph Gaal

G. Joseph Gaal

Fall is the perfect time to take care of things around the house and prepare for those long winter nights. As the season’s chore list grows, you may be tempted to stick with your current Medicare Advantage (Part C) or Part D prescription drug plan. But that plan may no longer be your best option.

Medicare’s Open Enrollment, which runs from October 15 to December 7, is your chance to review your coverage and see if you need to make any changes for 2016.

What’s all this Mail?

Seniors are inundated with mailings from different carriers promoting their plans this time of year, the majority of which you can toss. Things you want to look for is anything from Medicare, including their official “Medicare & You 2016” handbook, any notices from Social Security, and your current plan’s “Annual Notice of Change.”

By law, your plan should have notified you in September on how it will change for 2016, or if it’s no longer offered in your service area.

What’s Changing if I Do Nothing?

Many people like to pick a plan and stick with it. But even if you are happy with your current plan, you can’t assume it will continue “as is” for 2016.

You need to check what copays and coinsurances are changing. Some may go up, some down.

Check if your medications are still available and at what cost to you? Are there any new quantity limits or restrictions on your medications? How much will you have to pay for premiums, deductibles, doctor visits and hospital stays? Are your doctors still in the plan? Preferred pharmacies and hospitals? What’s your annual maximum out-of-pocket limit for 2016?

Whether you are on a Medicare Advantage (Part C) or a Part D prescription drug plan with Original Medicare, knowing what’s changing on your plan is essential to preventing any surprises after January 1.

If you’re still happy with your plan, you can do nothing and continue with your current plan coverage for 2016. (You must also continue to pay your Part B premium.)

I Want To Compare Plans. What’s Available?

There are a number of plans available in both Lorain and Cuyahoga counties to choose from. Best place to start is at www.medicare.gov and use their Medicare Plan Finder. Click on “Find Health and Drug Plans.”

It will take you through steps to include your medications, dosages, and your pharmacy. Then it pulls up the plans in your area, including details on premiums, deductibles and co-payments, and whether all your drugs are on the formulary. If you used the Personalized Search option, it will also pull up your current plan for comparison.

You will have to contact the plans or check their websites for up-to-date information and coverage of hospitals, doctors and other providers you use.

There are also Special Needs Plans available for people on Medicaid, or for people with chronic conditions such as diabetes, congestive heart failure, or certain types of cardiovascular disease. And there is also Extra Help to help pay for your medications if you qualify.

OK. I Want Help with All This.

The good news is you don’t have to go it alone, and no one’s going to charge for helping you. You can;

  • Call 1-800-Medicare (1-800-633-42270) to find out more about your coverage options. TTY users should call 1-800-325-0778.
  • Make an appointment with a counselor at your State Health Insurance Assistance Program (SHIP). Visit Medicare.gov/contacts or call 1-800-MEDICARE to get the phone number.
  • Make an appointment with an independent health insurance agent certified to offer plans in your area.

For detailed information on Part C & D Enrollment Periods, visit Medicare’s Tip Sheet at www.medicare.gov/Pubs/pdf/11219.pdf

Co­authors G. Joseph Gaal and Michel Anne Whitney are partners in The Whitney Insurance Group, Bay Village, Ohio, specializing in Group and Individual Health Plans, Retirement, Life, Disability, Annuities and Worksite Insurance. They can be reached at 216-­470-­2501 and 216­-704­-0234 respectively.

Co­authors G. Joseph Gaal and Michel Anne Whitney are partners in The Whitney Insurance Group, Bay Village, Ohio, specializing in Group and Individual Health Plans, Retirement, Life, Disability, Annuities and Worksite Insurance. They can be reached at 216-­470-­2501 and 216­-704­-0234 respectively.

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