On the Web
October 13, 2016
Medicare Enrollment Help is Plentiful
Open enrollment starts Oct. 15 for people who’ve signed up for Medicare and must buy into or change their supplemental Advantage or Part D prescription drug plans.
The Medicare Rights Center in New York tells me that you can “make as many changes as you need during this period” and that “only your last coverage choice will take effect Jan. 1.”
A long list of resources appears at the end of this blog to help Medicare beneficiaries through the enrollment process. But there’s a lot of hoopla around the Oct. 15-Dec. 7 enrollment period, so it’s important to know what Oct. 15 is not about.
One’s birthday – and not a date on the calendar – determines when people should initially enroll in the Medicare program. Most people turning 65 who are not covered by their own or their spouse’s employer health insurance at work are required to enroll in Medicare Parts A and B during a seven-month period that starts three months prior to their 65th birthday. During this seven-month window, new Medicare participants must also sign up for their Part D drug plans – or risk paying a lifelong penalty. Oct. 15 is not the trigger date for selecting Medigap plans either.
Here’s what the Medicare open enrollment that starts Oct. 15 is about: figuring out the right Advantage or Part D drug plan to buy or switch to. This is a complex process that involves multiple choices, anticipating your future health care needs and expenses, and a lot of research into the plans available.
It’s an implicit recognition of Medicare’s complexity that so many resources are available to help with this process, from private and government-funded consultants to YouTube videos and detailed web pages on the Medicare website. The following resources and blogs can help answer your questions:
- The first thing to determine is whether Advantage or Medigap, both of which help with copays and deductibles, is right for you. Advantage plan enrollment is on the rise, because these plans have lower premiums than Medigap plans. But some experts warned in a 2015 blog that Advantage plans have higher potential out-of-pocket costs, despite the lower premiums. A recent blog discusses the pitfalls of Advantage plans.
- Kathryn Votava, president of Goodcare.com, which consults with individuals and financial advisers about Medicare, said her firm just updated its Medicare guidebook for clients and now sells it online in an e-book or soft cover edition. “We’ve boiled down stuff we think people need,” she said.
- All Medicare enrollees are entitled to free help from government-sponsored Medicare consultants through a network of State Health Insurance Assistance Programs.
- The federal government’s Medicare website should be considered the final destination for accurate information about every aspect of coverage. It also includes videos and flyers in Spanish like the one at the top of this post.
- Many online videos explain how Medicare works. They are produced by everyone from Blue Cross and Blue Shield of Illinois to the Centers for Medicare and Medicaid Services. The Centers’ videos are particularly good at highlighting common mistakes and useful tips, often explained by a narrator who is crystal clear about crucial sign-up requirements. “If you’re actively working, that’s the only reason you can enroll late in Medicare” without a penalty, he explains in this video.
- Every year during open enrollment, Medicare enrollees must find a new Part D drug plan or re-enroll in their existing plan. To find the right plan, the Medicare Plan Finder searches online for plans suited to each individual’s needs and available in their geographic area.
- What is less well-known about Part D is that people who aren’t comfortable with the online tool or have complicated questions can call 1-800-633-4227 (1-800-Medicare) to work through specific issues with a human being who will guide their decision. In either case, have a list of all of your medications and dosages on hand to use the tool or speak with someone.
- Click here for more information about enrollment dates.
- The Medicare Rights Center offers “Six Things to Know About Fall Open Enrollment.”
Asked about her best advice for people who are unfamiliar with the Medicare landscape, Votava said this: don’t procrastinate.
“The vast majority of people enroll in the last seven days, Dec. 1-7,” she said. “It’s very frustrating then. The websites and the 800-numbers bog down. It’s an exercise in frustration. So start early.”
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Going it alone in reviewing your Medicare enrollment periods and coverage choices can lead to potentially costly mistakes. While the article has much useful information, several items could be clarified.
– You are not “required” to enroll in Medicare A or B, as the article points out, simply because you’re 65 and lack employer sponsored health insurance. Enrollment in Medicare is “voluntary” unless you are also drawing Soc. Sec. retirement. However you would be wise to enroll in both A and B, otherwise you will be subject to a “late enrollment” penalty for Part B unless you have maintained “creditable” coverage in the interim period.
– Individual Marketplace coverages (ACA or Obamacare plans) do not currently meet the definition of “creditable coverage” needed to avoid the Part B late enrollment penalty. There is a House Bill proposed to remedy this by granting Individual Marketplace plans and COBRA elections the same status as employer group plans for this purpose.
– The article incorrectly says you must “re-enroll” each year to maintain Part D drug coverage. If you are already enrolled in a plan and wish to keep it, you do not have to take any action…the plan will automatically renew Jan. 1. You only need to take action each year to change plans or enroll for the first time. The only exception would be if your plan was no longer being offered…in which case you need to find a new plan.
– In addition to the “Plan Finder” tool at Medicare.gov don’t overlook going directly to the drug plan website and use their search and pricing tool. While the Plan Finder is very accurate, there are cases where a specific drug may be listed incorrectly. If you’re on an expensive drug, it is worth the effort to double-check with the plan itself.
– The article makes no mention of working with a qualified independent insurance agent who specializes in Medicare coverages. Agents must undergo an annual re-certification process to meet CMS requirements to work in this market. This is my fourth year doing this and still took 10 hrs. of study, testing and a final timed exam to complete it. Each insurance plan I represent also requires re-certification. The whole process takes me a week to do. While there are nice people at most of the public resources, dept. of aging, etc. many simply lack the same level of training and experience actually enrolling people in plans. A good agent is a valuable resource and can save you lots of time and confusion.
– Medicare’s “open season” called the Annual Election Period (AEP) does NOT apply to Medicare Supplemental (Medigap) insurance. This is a common misconception. The AEP is for Part C (Medicare Advantage) and Part D drug plans, ONLY.
Disclosure: I am a licensed health insurance agent serving MD, VA and DC and am enrolled in Medicare A and B.
I’m turning 65 in December and still working. As I understand it, I am required to enroll in Medicare Part A but don’t have to enroll in Part B since I still get coverage from my employer. Is this correct?
If you are receiving coverage from your employer you do not need to enroll in Medicare part A or B. If your coverage comes through an employer with a group of 20 or more your employer coverage it can remain primary therefore, you do not need Medicare part A or B as long as you have that coverage. If the coverage is “creditable” for Medicare part D you can defer enrolling in Medicare part D as well. At some future time when you leave the employer coverage you will be entitled to a special enrollment period and be able to enter into Medicare part A, B and D without a penalty or a gap in coverage. I cover this and more in my book “Making the Most of Medicare: a Guide for Baby Boomers”. You and find that at http://www.goodcare.com.
This is an important piece. Thank you for starting this and giving links to Do-it-Yourselfers
I can attest to the value of working with “qualified independent insurance agent who specializes in Medicare coverages.” As a recently retired professor with a Ph.D. in personal finance who is used to reading obscure and arcane academic documents, I was thoroughly perplexed about my Medicare choices until I met with a trained insurance agent. Not only were the agent and staff helpful in making enrollment choices, they helped resolve some follow-up problems (at no cost to me).
Dave & Katy – thank you for your expert input!
Readers, as the blog’s writer, I strongly advise you also to speak with someone in person to make certain your very specific questions are answered and verify information online at Medicare.gov.
Thank you for reading the blog.
Some employers will request that employees enroll in Medicare A at age 65. There is no premium for Medicare A.