6 things to know about Medi­care Open En­roll­ment

Daily Local News (West Chester, PA) - - BUSINESS - Janet Col­li­ton Colum­nist

It’s Medi­care Open En­roll­ment time again and that means time for an­other re­fresher on what that ex­pres­sion means. The first thing you need to know, by the way, is not to get Medi­care Open En­roll­ment con­fused with Open En­roll­ment for the Health­care Mar­ket­place. Medi­care Open En­roll­ment is for those age 65 and older or dis­abled un­der So­cial Se­cu­rity Dis­abil­ity for two years who want to en­roll in or change Medi­care Ad­van­tage or Medi­care D pre­scrip­tion plans. The Health­care Mar­ket­place, on the other hand, is ba­si­cally for ev­ery­one else in­clud­ing younger peo­ple and those who are not dis­abled but do not have health in­sur­ance ei­ther through an em­ployer or oth­er­wise. The dates for en­rolling for the two “Open En­roll­ments” are dif­fer­ent.

Here are FAQ’s for what you need to know about Medi­care Open En­roll­ment.

1. When is Medi­care Open En­roll­ment for 2017 Cov­er­age? Medi­care Open En­roll­ment for 2017 runs from Oc­to­ber 15, 2016 to De­cem­ber 7, 2016. If you are just be­com­ing el­i­gi­ble for Medi­care (such as just turn­ing age 65), you can sign up for Medi­care as soon as you be­come el­i­gi­ble re­gard­less of the month. But each year, if you are in a Medi­care Ad­van­tage plan or

Medi­care D pre­scrip­tion drug plan, you can change your en­roll­ment to an­other Medi­care Ad­van­tage or Medi­care D plan between Oc­to­ber 15 to De­cem­ber 7 ef­fec­tive the fol­low­ing year.

2. Do I Need To Do Any­thing Dur­ing Open En­roll­ment? Not nec­es­sar­ily. If you have cov­er­age and are con­tent with what you have you might just ride out the pe­riod un­til next year. How­ever, Medi­care Open En­roll­ment gives the op­por­tu­nity to change. Health in­sur­ers can make changes in cost, cov­er­age and what health care providers and phar­ma­cies are in their net­work. These might make a dif­fer­ence to you. Check out your plan. Check to see whether your med­i­ca­tions are still cov­ered and are con­sid­ered in the same tier. Check to see the providers if you have a plan that lim­its providers, and look to see whether your doc­tor, hospi­tal and phar­macy are still cov­ered.

3. I am on a Medi­care Sup­ple­ment Plan. Do I need to check out Open En­roll­ment? Open en­roll­ment re­lates to Medi­care Ad­van­tage plans and Medi­care D pre­scrip­tion plans. If you have a Medi­care Sup­ple­ment Plan, the Open En­roll­ment pe­riod does not ap­ply to you un­less you want to sign up for Medi­care Ad­van­tage or you have a Medi­care D pre­scrip­tion plan and want to change.

4. Are there any other lim­i­ta­tions in­volved in chang­ing plans? When you are first en­rolling in Medi­care, you have the right and the abil­ity to choose to en­roll for a Medi­care Sup­ple­ment plan with­out re­gard to your health. Medi­care Sup­ple­ment plans are typ­i­cally more ex­pen­sive. Some­times, to save money, en­rollees might ini­tially sign up for a Medi­care Ad­van­tage plan. If they do and later ex­pe­ri­ence poor health they can be de­nied the abil­ity to switch to a Medi­care Sup­ple­ment for bet­ter cov­er­age. If you are al­ready in a Medi­care Ad­van­tage plan, you can switch to an­other Medi­care Ad­van­tage plan with­out med­i­cal un­der­writ­ing and your health is not a con­sid­er­a­tion in chang­ing plans dur­ing the Open En­roll­ment pe­riod.

5. There is a wide di­ver­sity of cov­er­age among Medi­care Ad­van­tage (HMO, PPO, PFFS) plans. Not all Medi­care Ad­van­tage plans are the same. Also, they are typ­i­cally di­vided into cat­e­gories such as HMO, PPO, PFFS. The Medi­care Ad­van­tage HMO might or might not limit your providers. It is less likely to be “por­ta­ble” that is to pro­vide cov­er­age if you move to an­other cov­er­age area, an­other state or an­other part of the coun­try. PPO’s typ­i­cally al­low more flex­i­bil­ity and are more likely to be trans­portable. If you have a choice between an HMO and a PPO, the PPO more of­ten is the bet­ter choice. PFFS plans are not nec­es­sar­ily rec­og­nized by all med­i­cal providers who take Medi­care.

6. It is im­por­tant to know how pre­scrip­tion drugs and med­i­cal cov­er­age work and the dif­fer­ences between Medi­care Sup­ple­ment and Medi­care Ad­van­tage. Medi­care Sup­ple­ment plans do not them­selves have pre­scrip­tion drug cov­er­age but rather are of­ten mar­keted with a separate PDP or pre­scrip­tion drug plan (look for PDP or Rx on the card). Medi­care Ad­van­tage plans usu­ally come with pre­scrip­tion cov­er­age.

If you are con­fused, get help. The Ch­ester County AP­PRISE pro­gram staffed by vol­un­teers, is ex­cel­lent. It can be con­tacted at 610344-6035.

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