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Dear Friends,

Medicare Open Enrollment is coming up; there are a few things you need to know.

Fall Open Enrollment runs October 15 through December 7 and is the time of year when you can make changes to your Medicare coverage. Any changes you make will take effect on January 1, 2021. Take action to make sure your coverage will meet your needs in in the coming year.

Know the changes you can make during Fall Open Enrollment

The changes you can make include:

• Joining a new Medicare Advantage Plan or Part D prescription drug plan
• Switching from Original Medicare to a Medicare Advantage Plan
• Switching from a Medicare Advantage Plan to Original Medicare (with a Part D plan)

Review your coverage for 2021

If you have Original Medicare, visit medicare.gov or read the 2021 Medicare & You handbook to learn about Medicare’s benefits for the upcoming year.

Medicare Advantage and Part D plans usually change each year. Make sure that your drugs will still be covered next year and that your providers and pharmacies will still be in the plan’s network. If you have a Medicare Advantage Plan or a stand-alone Part D plan, read your plan’s Annual Notice of Change and/or Evidence of Coverage (EOC). If you do not receive your notice, contact your plan to request copies. Explore other plans in your area; you may find a cheaper plan that meets your needs. Research shows that people with prescription drug plans can lower their costs by shopping among plans each year.

What are some things I should consider when choosing a Part D prescription drug plan?

Ask yourself the following questions before choosing a Part D drug plan:

• Does the plan cover all the medications I take?
• Does the plan have restrictions on my drugs (i.e. prior authorization, step therapy, or quantity limits?)
  • Prior authorization means that you must get approval from your Part D plan before the plan will pay for the drug.
  • Step therapy means that your plan requires you to try a cheaper version of your drug before it will cover the more expensive one.
  • Quantity limits restrict the quantity of a drug you can get per prescription fill, such as 30 pills of Drug X per month.
• How much will I pay for monthly premiums and the annual deductible?
• How much will I pay at the pharmacy (copay/coinsurance) for each drug I take?
• Is my pharmacy in the plan’s preferred network? You pay the least if you used preferred network pharmacies.
• Can I fill my prescriptions by mail order?

You may find it helpful to use Medicare’s Plan Finder tool, which gives you a list of Medicare Part D plans, the drugs they cover and their estimated costs for the year. You can access Plan Finder at medicare.gov or by calling 1-800-MEDICARE. If you create a MyMedicare online account, you will find all your prescription medications already listed on your profile as well as your current plan. This makes comparing plans much easier.

What are some things I should consider when choosing a Medicare Advantage Plan?

Ask yourself the following questions before choosing a Medicare Advantage Plan:

• How much are the premium, deductible and coinsurance/copay amounts?
• Can I see out of network providers? Look for PPO plans.
• What is the annual maximum out-of-pocket cost for the plan? This amount may be high but can help protect you if you have expensive health care costs.
• What service area does the plan cover?
• Are my doctors and hospitals in the plan’s network?
• What are the rules I have to follow to access health care services and my drugs?
• Does the plan cover additional health care benefits that are not covered by Original Medicare?

Medicare Advantage Plans usually include prescription drug coverage. You should also consider the questions listed for Part D in choosing a Medicare Advantage Plan to make sure that the prescription drug coverage the plan offers meets your needs.

If I switch to Original Medicare during Fall Open Enrollment, can I purchase a Medigap policy to help with cost-sharing gaps?

Medicare supplement insurance policies, commonly called Medigaps, are health insurance policies that offer standardized benefits to work with Original Medicare (not with Medicare Advantage). They are sold by private insurance companies. If you have a Medigap, it pays part or all of certain cost-sharing “gaps” that remain after Original Medicare pays first. Depending on where you live, you may be able to purchase a Medigap policy during Fall Open Enrollment, but certain limitations apply as to who can buy a Medigap and when. It is important to contact your State Health Insurance Assistance Program (SHIP) to learn about Medigap enrollment rights in your state before you make your Open Enrollment choices. To find your SHIP, call 877-839-2675 or visit shiptacenter.org

Will I have opportunities to change my coverage in the coming year?

You should make any necessary changes to your Medicare coverage by December 7, 2020 in order for the changes to take effect January 1, 2021.

In 2021, you may have the opportunity to make changes if you have a Medicare Advantage Plan. You’ll be able to make one change to your coverage between January 1 and March 31. This enrollment period is only for people who are enrolled in a Medicare Advantage Plan and not for those enrolled in Original Medicare.

Protect yourself from marketing violations and enrollment fraud

During Fall Open Enrollment, there is a higher risk than usual for fraudulent activity. Medicare has rules about how plans can and cannot communicate with you to market their insurance products. Plans are allowed to send you mail, but are not allowed to call, email or visit you in person without your permission. Watch out for people who pressure you to join their plan, tell you they represent Medicare and want to offer free services, or inform you that you will lose your Medicare benefits unless you sign up for a certain plan.

Contact your Senior Medicare Patrol (SMP) if you receive any notices that seem suspicious. SMP representatives can teach you how to spot and protect yourself from potential Medicare fraud. Visit smpresource.org or call 877-808-2468.

Yours in good health,

Debbie Kraus
Health Benefits Specialist

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