Medicare Open Enrollment

Medicare Open Enrollment has arrived. The open enrollment period for 2014 runs from October 15-December 7, 2013. This is not only a period where you may enroll for the program, but also switch providers for your comprehensive health and drug coverage. (1)

Some key dates to remember. This fall and winter, there are three periods in which Medicare beneficiaries can either enroll or disenroll in forms of coverage:

>> Now through December 7: Open enrollment period. This is when you can elect to leave Original Medicare (Parts A and B) for a Medicare Advantage Plan (Part C) and change your prescription drug coverage (Part D). You can also elect to get out of a Part C plan and go back to Parts A and B during this period. (1,2)

>> December 8: Annual enrollment period begins for 5-star plans. As you probably know, Part C and Part D plans are assigned ratings. Beginning December 8, 2013 and ending November 30, 2014, a window opens for you to enroll in a 5-star Part C or Part D plan. You can do this once per 365 days. How do you find the 5-star plans? Visit www.medicare.gov/find-a-plan. (2,3)

>> January 1-February 14: Disenrollment period. If you join a Part C plan in late 2013 and want to reverse that decision, you can disenroll from that Medicare Advantage plan in this window of time and go back to Original Medicare with a stand-alone Prescription Drug Plan (Part D). (2,3)

Do you have to enroll in Medicare through the new health insurance exchanges? No. Medicare isn’t part of that. If you have Medicare, you are already insured in the eyes of the federal government. You don’t have to make any changes to your Medicare coverage because of the implementation of the exchanges, and your Medicare benefits won’t change as a result of them, whether you have Original Medicare or a Medicare Advantage plan through an HMO or PPO. (4)

In case you are wondering, you can’t buy Part D prescription drug coverage or Medigap insurance through the new online health insurance exchanges. (4)

What should you look for in a Part C or Part D plan? Be sure to take a look at a few key factors.

>> While premiums matter, overall plan expenses ultimately matter most; scrutinize the copays, the co-insurance and the yearly deductibles as well. Attractively low premiums might not tell you the whole story about the value of a Medicare Advantage plan.

>> How inclusive is the plan network? Assuming the plan has one, does it include the hospitals you would choose and the physicians that now treat you?

>> Regarding Part D, how wide-ranging is the prescription drug coverage? Look at the list of approved drugs (the formulary). If the drugs you want or need aren’t listed, you are probably going to have to open your wallet to pay for them. The frustrating thing about formularies is how they change; drugs on this year’s list may not always be on next year’s list.

>> Every fall, Medicare plans mail out Annual Notice of Change (ANOC) letters to their plan members. Use this notice to determine if your current plan is still right for you and your medical care needs. If you didn’t receive such a letter in September, contact your plan. (5)

How expensive will Part D coverage be next year? According to CBS MoneyWatch, monthly premiums for a stand-alone Medicare Prescription Drug Plan (PDP) under Medicare Part D are projected at $31 for 2014. (6)

The initial deductible for standard Part D prescription drug coverage will be $310 next year. After your total prescription drug costs surpass $310, you'll pay 25% of your total drug costs between $310-2,970. You’ll find yourself in the “doughnut hole” between $2,970-4,550 (wherein you pay 100% of any drug costs under the standard plan). Should your total prescription drug costs exceed $4,550 in 2014, you'll be eligible for catastrophic coverage, leaving you on the hook for just 5% of drug costs above that level. (6)

Citations.

1 - cms.gov/Center/Special-Topic/Open-Enrollment-Center.html [10/11/13]

2 - medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/five-star-enrollment/5-star-enrollment-period.html [10/11/13]

3 - medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html#collapse-3192 [10/11/13]

4 - q1medicare.com/PartD-Important-Dates-To-RememberPartD.php [9/13]

5 - medicare.gov/forms-help-and-resources/mail-about-medicare/plan-annual-notice-of-change.html [10/11/13]

6 - cbsnews.com/8301-505146_162-57605987/medicare-open-enrollment-prescription-drug-basics/ [10/7/13]