Tips to help you nav­i­gate Medi­care open en­roll­ment

Daily Local News (West Chester, PA) - - FIFTY PLUS -

We are in the midst of the Medi­care An­nual Open En­roll­ment Pe­riod (AOEP); Oct. 15 to Dec. 7, 2016, when Medi­care ben­e­fi­cia­ries have the op­tion to change their Medi­care plans to bet­ter meet their needs in 2017. Open En­roll­ment is the time to make changes to Medi­care Ad­van­tage (HMO, PPO, PFFS) Plans and Part D Pre­scrip­tion Drug Plans. Some re­tiree plans also con­duct Op­tion Se­lec­tion Pe­ri­ods to co­in­cide with Medi­care’s AOEP. If you have a re­tiree plan, fol­low the in­struc­tions for mak­ing changes from your plan.

It is com­mon for Medi­care Pre­scrip­tion Drug Plans and Medi­care Ad­van­tage Plans with drug cov­er­age, to change their for­mu­la­ries, or list of cov­ered drugs each year. These changes to cov­er­age were sent to you some­time dur­ing Septem­ber by your cur­rent plan in no­tices called An­nual No­tice of Change (ANOC) and/or Ev­i­dence of Cov­er­age (EOC).

By Sept. 30, you should have re­ceived the ANOC and EOC from your cur­rent plan out­lin­ing the 2017 de­tails of the plan.

Your plan may no longer cover all of your drugs in 2017, or your drugs may change to a more ex­pen­sive Tier, or there may be other changes that make your cur­rent plan less cost ef­fec­tive for you. If this is the case, you may want to see if there is a bet­ter op­tion. You are given the An­nual Open En­roll­ment Pe­riod to en­roll in a new pre­scrip­tion drug plan. Changes made dur­ing Open En­roll­ment will be ef­fec­tive Jan. 1, 2017. Do not as­sume that what you se­lected last year will re­main the same, or that it will be the best for you in 2017.

Crit­i­cal fac­tors to con­sider when choos­ing a new Part D plan are (1) cost, (2) whether all of your med­i­ca­tions are on the plan’s for­mu­lary and (3) whether your phar­macy is par­tic­i­pat­ing as a pre­ferred net­work phar­macy or a stan­dard cost­shar­ing phar­macy. If you would like to try us­ing the Medi­care Plan Finder, here are a few tips from The Medi­care Rights Cen­ter to fa­cil­i­tate your search.

The Medi­care Rights Cen­ter http://www.medi­carerights.org/ states in one of their re­cent news­let­ters:

“You can find a new Part D plan by us­ing the Medi­care Plan Finder, an on­line tool at www.medi­care.gov that can be used to com­pare stand-alone Part D plans or Medi­care Ad­van­tage Plans with pre­scrip­tion drug cov­er­age. Plan Finder pro­vides in­for­ma­tion about costs, in­clud­ing monthly pre­mi­ums, de­ductibles and co­pay­ments, which drugs are in­cluded on the plan’s for­mu­lary, and the star rat­ing of the plan.

“To use Plan Finder you will need to go to www. medi­care.gov and click on the green but­ton that says ‘Find health and drug plans’. You can do a gen­eral search by en­ter­ing a zip code, or you can do a per­son­al­ized search by en­ter­ing more in­for­ma­tion, such as your Medi­care num­ber and date of birth. Next you can en­ter the drugs you take and choose the phar­ma­cies you like to go to. Plan Finder will dis­play re­sults for plans that cover your drugs and have your phar­ma­cies in their net­works. Note that a plan may not cover all of the drugs you take, but it may have al­ter­na­tives on its for­mu­lary. Plan Finder also tells you if the plan has a de­ductible and how much the monthly pre­mium is. It is a good idea to call the plan di­rectly to con­firm any in­for­ma­tion you read on Plan Finder, as in­for­ma­tion may not be com­pletely up to date. You can en­roll in a plan on­line, or by call­ing 1-800-MEDI­CARE, or by call­ing the plan di­rectly.

“You can make as many changes as you want be­tween Oct. 15 and Dec. 7, but only the last change you make will take ef­fect on Jan. 1, 2017. If you choose a plan and re­al­ize that it is the wrong plan after Fall Open En­roll­ment is over, in most cases you will not be able to change your cov­er­age un­til the next Fall Open En­roll­ment Pe­riod. For this rea­son, it is im­por­tant to care­fully con­sider all of your op­tions and take the time to make the right de­ci­sion for your health care needs. “

While noted above, you can call the plan or Medi­care to en­roll in a new plan. The Ch­ester County APPRISE pro­gram is lo­cal and coun­selors can help you nav­i­gate this process. An APPRISE coun­selor can help you en­roll in a plan that might pro­vide bet­ter cov­er­age and have lower pre­mium. The coun­selor can also screen you for any as­sis­tance pro­grams that could help you bet­ter af­ford your Medi­care and pos­si­bly lower the cost of your drug cov­er­age.

So, what can you do be­tween Oct. 15 and Dec. 7? You can make changes to your present Medi­care Ad­van­tage Plan or your Pre­scrip­tion Drug Plan us­ing the tools on www. Medi­care.gov. If your sit­u­a­tion is more com­pli­cated or you do not feel com­fort­able work­ing on­line, an APPRISE state-cer­ti­fied coun­selor will be able to as­sist you. APPRISE coun­selors will be avail­able at se­nior cen­ters, sev­eral li­braries and other lo­ca­tions through­out the county dur­ing this time pe­riod. To make an ap­point­ment, leave a mes­sage at 610-344-5234 or you may call a se­nior cen­ter di­rectly. You can also email us with ques­tions at ap­prisech­esco@out­look.com.

The Ch­ester County Department of Ag­ing, through its APPRISE pro­gram of trained Medi­care coun­selors, helps Medi­care ben­e­fi­cia­ries to un­der­stand the health care op­tions spe­cific to their health needs and fi­nan­cial re­sources. This is one in a se­ries of ar­ti­cles pre­pared by APPRISE vol­un­teers to help Medi­care ben­e­fi­cia­ries nav­i­gate this com­plex sys­tem. APPRISE is a free, con­fi­den­tial and un­bi­ased ser­vice pro­vided by the Penn­syl­va­nia Department of Ag­ing, and locally un­der the aus­pices of the Ch­ester County Department of Ag­ing.

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