IT’S THAT TIME OF THE YEAR-MEDICARE OPEN ENROLLMENT
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:
- 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.
- 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.
- 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.
- 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. Any questions about Medicare and to report any Medicare scams, call the Senior Medicare Patrol of New Jersey at 732-777-1940.