Beneficiaries who were in a Medicare Advantage (MA) Plan which did not renew its contract with the Centers for Medicare & Medicaid Services on January 1, or which reduced their service area so that you are no longer in it, may enroll in a Medicare Advantage Plan until January 31, 2011. Your effective date of enrollment will be February 1, 2011.
By the same token, a Medicare beneficiary who was in a Part D prescription drug plan (PDP) which did not renew its contract with the Centers for Medicare & Medicaid Services on January 1, may enroll in a Part D prescription drug plan until January 31, 2011. Your effective date of enrollment will be February 1, 2011.
These special election periods are available because, with the deluge of Medicare information and advertisements you got toward the end of 2010 you might not have clearly realized your Medicare Advantage Plan or your Part D stand-alone drug plan would not be available to you in 2011.
So make haste: if you want to rejoin a Medicare Advantage Plan or a Part D stand-alone drug plan, do so quickly before the end of this month! You may wish to call 1-800-MEDICARE or your State Health Insurance Assistance Program. Its number is on the back of your Medicare & You 2011 handbook.
Wednesday, January 26, 2011
Sunday, January 16, 2011
Special Enrollment Period in Georgia and Tennessee
The Centers for Medicare & Medicaid Services recently announced a special enrollment period (SEP) for certain beneficiaries who reside in two states – Georgia and Tennessee. Both of these states have enacted legislation requiring Medicare supplement (also called Medigap) insurers to sell policies to Medicare beneficiaries under 65 – that is, those who have Medicare because they are disabled or have end stage renal disease. These Medicare supplement or Medigap policies are explained in chapter 11 of Managing Your Medicare.
Georgia has established a special open enrollment period for these individuals to buy a Medigap supplement policy effective from November 1, 2010 to May 1, 2011. In Tennessee, this runs from January 1, 2011 to June 30, 2011.
This Medicare special enrollment period is highly restrictive and is intended, solely for Medicare beneficiaries under age 65 who are now in a Medicare Advantage Plan, to be able to disenroll from their Plan, and, making use of this new state legislation, to go into Original (fee-for-service) Medicare with a Medigap supplement.
Medicare’s special enrollment period for these individuals is tailored to these states’ respective open enrollment periods. It will begin on February 15, 2011 (the day after the Medicare Advantage Annual Disenrollment Period ends, see my posting of January 4, 2011 on this) and will run to May 1, 2011 in Georgia and June 30, 2011 in Tennessee.
The special enrollment period allows a Medicare beneficiary under age 65 enrolled in a Medicare Advantage Plan to prospectively disenroll from that Plan and return to Original Medicare. Once the individual has Original Medicare, they will be eligible to purchase a Medigap supplement policy following their state’s Medigap open enrollment period guidelines. Disenrollment requests received by Medicare Advantage Plans are effective the first day of the month following the month the organization receives the request. Beneficiaries may not join or switch Medicare Advantage Plans under this special enrollment period. (You can disenroll by contacting your Plan or by calling 1-800-MEDICARE.)
Two important caveats. Technically, you can’t purchase a Medigap policy while you are in a Medicare Advantage Plan. That’s why Medicare says you must “prospectively disenroll.” One way around this is to see if your insurer will sell you the policy on the first day of your return to Original Medicare and make the policy effective with that day. Otherwise you face a period where you have no coverage for Medicare’s deductibles and coinsurances, which could be very expensive to you if you get seriously ill.
The other is that if you have Part D prescription drug coverage with your Medicare Advantage Plan, and you disenroll from your Plan, you will lose your Part D drug coverage unless you enroll in a stand-alone Part D drug plan. (Sometimes these are called a “PDP”.) Fortunately, this special enrollment period allows you to enroll in such a drug plan. Your enrollment will be effective with the first day of the month following the month you make your enrollment request. So you can keep your drug coverage without a break if you enroll in a drug plan the same month you give your disenrollment notice to your Medicare Advantage Plan. Be sure you do your homework ahead of time and find the best drug plan for you. And remember that if you happen to be in a Medicare Advantage Plan that requires no premium, you will have to pay a premium for a stand-alone drug plan.
If you do NOT have drug coverage at this time, you may NOT use this Special enrollment period to sign up for it. And if you have drug coverage with a stand-alone plan at this time, you may not disenroll from it or change plans. Only those that have drug coverage with their Medicare Advantage Plan and who disenroll from it can sign up for a stand-alone drug plan.
So if you are interested, you should contact your state department of insurance (for Georgia, this is the Office of Insurance and Safety Fire Commissioner, www.gainsurance.org or toll free1-800-656-2298; for Tennessee, it’s the Department of Commerce and Insurance, www.state.tn.us./commerce or toll-free 1-800-342-4029) and ask for information about Medigap policies for beneficiaries under age 65. Check out the benefits and premiums, and decide whether you want to go to Original Medicare with a Medigap supplement. And while most health care providers are willing to take beneficiaries who are insured with Original Medicare with a Medigap policy, you should always check with your providers to see if they do so before you make a change.
And, of course, don’t forget the deadlines of May 1, 2011 in Georgia and June 30, 2011 in Tennessee.
Georgia has established a special open enrollment period for these individuals to buy a Medigap supplement policy effective from November 1, 2010 to May 1, 2011. In Tennessee, this runs from January 1, 2011 to June 30, 2011.
This Medicare special enrollment period is highly restrictive and is intended, solely for Medicare beneficiaries under age 65 who are now in a Medicare Advantage Plan, to be able to disenroll from their Plan, and, making use of this new state legislation, to go into Original (fee-for-service) Medicare with a Medigap supplement.
Medicare’s special enrollment period for these individuals is tailored to these states’ respective open enrollment periods. It will begin on February 15, 2011 (the day after the Medicare Advantage Annual Disenrollment Period ends, see my posting of January 4, 2011 on this) and will run to May 1, 2011 in Georgia and June 30, 2011 in Tennessee.
The special enrollment period allows a Medicare beneficiary under age 65 enrolled in a Medicare Advantage Plan to prospectively disenroll from that Plan and return to Original Medicare. Once the individual has Original Medicare, they will be eligible to purchase a Medigap supplement policy following their state’s Medigap open enrollment period guidelines. Disenrollment requests received by Medicare Advantage Plans are effective the first day of the month following the month the organization receives the request. Beneficiaries may not join or switch Medicare Advantage Plans under this special enrollment period. (You can disenroll by contacting your Plan or by calling 1-800-MEDICARE.)
Two important caveats. Technically, you can’t purchase a Medigap policy while you are in a Medicare Advantage Plan. That’s why Medicare says you must “prospectively disenroll.” One way around this is to see if your insurer will sell you the policy on the first day of your return to Original Medicare and make the policy effective with that day. Otherwise you face a period where you have no coverage for Medicare’s deductibles and coinsurances, which could be very expensive to you if you get seriously ill.
The other is that if you have Part D prescription drug coverage with your Medicare Advantage Plan, and you disenroll from your Plan, you will lose your Part D drug coverage unless you enroll in a stand-alone Part D drug plan. (Sometimes these are called a “PDP”.) Fortunately, this special enrollment period allows you to enroll in such a drug plan. Your enrollment will be effective with the first day of the month following the month you make your enrollment request. So you can keep your drug coverage without a break if you enroll in a drug plan the same month you give your disenrollment notice to your Medicare Advantage Plan. Be sure you do your homework ahead of time and find the best drug plan for you. And remember that if you happen to be in a Medicare Advantage Plan that requires no premium, you will have to pay a premium for a stand-alone drug plan.
If you do NOT have drug coverage at this time, you may NOT use this Special enrollment period to sign up for it. And if you have drug coverage with a stand-alone plan at this time, you may not disenroll from it or change plans. Only those that have drug coverage with their Medicare Advantage Plan and who disenroll from it can sign up for a stand-alone drug plan.
So if you are interested, you should contact your state department of insurance (for Georgia, this is the Office of Insurance and Safety Fire Commissioner, www.gainsurance.org or toll free1-800-656-2298; for Tennessee, it’s the Department of Commerce and Insurance, www.state.tn.us./commerce or toll-free 1-800-342-4029) and ask for information about Medigap policies for beneficiaries under age 65. Check out the benefits and premiums, and decide whether you want to go to Original Medicare with a Medigap supplement. And while most health care providers are willing to take beneficiaries who are insured with Original Medicare with a Medigap policy, you should always check with your providers to see if they do so before you make a change.
And, of course, don’t forget the deadlines of May 1, 2011 in Georgia and June 30, 2011 in Tennessee.
Wednesday, January 12, 2011
Part D Transition Process
There is an important protection for Medicare beneficiaries called the “transition process” which applies for the first 90 days you are in a Medicare Part D drug plan. During this period it generally allows a beneficiary to continue to receive any prescription drug they were taking (1) whether or not the drug is on their plan’s formulary, and (2) even if it is on the formulary, if it has restrictions due to prior authorization or step therapy. Under this process, a beneficiary new to a plan can always get up to a 30-day supply of a drug; this will give them time to seek an alternate drug with their prescriber, or get a formulary exception from their plan, or attempt to find another way to pay for their drug. However, this process does not apply to drugs not covered by Part D. (This list is on page 95 of Managing Your Medicare.)
In these cases, a plan must supply a beneficiary with up to a 30-day supply of their prescription, and it must also notify the beneficiary, within three business days and by first class mail, that it is only a “temporary fill.” (These are also sometimes called “transition supplies” or “emergency supplies.”) The plan must also make a reasonable attempt to notify the prescriber of this. If the prescription is for multiple fills of less than 30 days, for example, four 7-day fills, the plan still must refill it up to a 30 days supply. (Note that for beneficiaries in long term care the plan must fill up to a 93-day supply in 31 day increments.)
Note that you are not expected to ask for this process to occur; it is supposed to be automatic. For example, if during your first 90 days in a drug plan you go to the pharmacy to get a prescription filled, and it so happens that your drug is not on your plan’s formulary, you plan is supposed to fill your prescription (up to a 30-day supply) without any intervention on your part. And that is why the notification part of this process is so important – you otherwise would probably assume that your drug is always going to be covered – and so it is critical that your plan notify you (and your prescriber) that this is NOT the case. However, if for some reason they do not automatically fill your prescrition, you can always call them and ask for a transitional fill.
And this process applies at other times than when you change or join a plan on January 1. The transition process applies to any beneficiary who joins a Part D plan whether or not they were previously in a plan (for example, they may change plans in the middle of a year because they changed residence; or perhaps they involuntarily lost their creditable drug coverage and they now first join a plan).
And, importantly, it applies to those who are in a plan when the plan changes its formulary so their drug is no longer covered by their plan, or when their plan now imposes prior authorization or step therapy on their drug. Because formulary changes often take place on January 1 of a calendar year, beneficiaries who stay in the same plan are also covered by this process when the formulary changes at that time. And in these cases where the formulary changes, the-90 day window starts when the formulary changes.
So be sure to act promptly if you get a notice that your drug is not ordinarily covered, or that your plan will begin prior authorization or step therapy.
And remember, you always have your appeal rights to try to get your plan to cover a drug you need. You are certainly free to use them when you find out your drug is not on the formulary or will be subject to prior authorization or step therapy. The notice you get from your plan will tell you how to make an exception request and of your appeal rights; all these Part D appeals rights are also fully spelled out beginning on page 206 of Managing Your Medicare.
Change of Care Transitions
Note that there is another transition which Centers for Medicare & Medicaid Services has instructions on. This is called a “change of care transition.” This is when a beneficiary who is enrolled in Part D goes from one institution to another (especially from one that provides all their medicines, such as an inpatient hospital or Skilled Nursing Facility) to one that does not, such as a long term care facility), or from an institution to home, or even beneficiaries who opt to end their hospice care and go back to regular care. (Hospices supply some medications under the Part A benefit, but a when a beneficiary is discharged from a hospice, not only will the beneficiary become responsible for their medications, but their medications may well change on discharge.) In these cases the Centers for Medicare & Medicaid Services has asked that drug plans consider using the transition process, but they are not required to do so. So you can at least review your plan’s literature to see what their policy is, or ask them. And if they do not have a transition policy for these cases, you will have to use the expedited appeals process to try to get a medicine that is not on your plan’s formulary or which requires prior authorization or step therapy.
In these cases, a plan must supply a beneficiary with up to a 30-day supply of their prescription, and it must also notify the beneficiary, within three business days and by first class mail, that it is only a “temporary fill.” (These are also sometimes called “transition supplies” or “emergency supplies.”) The plan must also make a reasonable attempt to notify the prescriber of this. If the prescription is for multiple fills of less than 30 days, for example, four 7-day fills, the plan still must refill it up to a 30 days supply. (Note that for beneficiaries in long term care the plan must fill up to a 93-day supply in 31 day increments.)
Note that you are not expected to ask for this process to occur; it is supposed to be automatic. For example, if during your first 90 days in a drug plan you go to the pharmacy to get a prescription filled, and it so happens that your drug is not on your plan’s formulary, you plan is supposed to fill your prescription (up to a 30-day supply) without any intervention on your part. And that is why the notification part of this process is so important – you otherwise would probably assume that your drug is always going to be covered – and so it is critical that your plan notify you (and your prescriber) that this is NOT the case. However, if for some reason they do not automatically fill your prescrition, you can always call them and ask for a transitional fill.
And this process applies at other times than when you change or join a plan on January 1. The transition process applies to any beneficiary who joins a Part D plan whether or not they were previously in a plan (for example, they may change plans in the middle of a year because they changed residence; or perhaps they involuntarily lost their creditable drug coverage and they now first join a plan).
And, importantly, it applies to those who are in a plan when the plan changes its formulary so their drug is no longer covered by their plan, or when their plan now imposes prior authorization or step therapy on their drug. Because formulary changes often take place on January 1 of a calendar year, beneficiaries who stay in the same plan are also covered by this process when the formulary changes at that time. And in these cases where the formulary changes, the-90 day window starts when the formulary changes.
So be sure to act promptly if you get a notice that your drug is not ordinarily covered, or that your plan will begin prior authorization or step therapy.
And remember, you always have your appeal rights to try to get your plan to cover a drug you need. You are certainly free to use them when you find out your drug is not on the formulary or will be subject to prior authorization or step therapy. The notice you get from your plan will tell you how to make an exception request and of your appeal rights; all these Part D appeals rights are also fully spelled out beginning on page 206 of Managing Your Medicare.
Change of Care Transitions
Note that there is another transition which Centers for Medicare & Medicaid Services has instructions on. This is called a “change of care transition.” This is when a beneficiary who is enrolled in Part D goes from one institution to another (especially from one that provides all their medicines, such as an inpatient hospital or Skilled Nursing Facility) to one that does not, such as a long term care facility), or from an institution to home, or even beneficiaries who opt to end their hospice care and go back to regular care. (Hospices supply some medications under the Part A benefit, but a when a beneficiary is discharged from a hospice, not only will the beneficiary become responsible for their medications, but their medications may well change on discharge.) In these cases the Centers for Medicare & Medicaid Services has asked that drug plans consider using the transition process, but they are not required to do so. So you can at least review your plan’s literature to see what their policy is, or ask them. And if they do not have a transition policy for these cases, you will have to use the expedited appeals process to try to get a medicine that is not on your plan’s formulary or which requires prior authorization or step therapy.
Tuesday, January 11, 2011
Part D Late Enrollment Penalty Appeals
For those of you who have just joined a drug plan, or for those of you who have switched drug plans, you may need some guidance on how to deal with a few issues that may come up. And remember, this advice is good if your Medicare drug plan is a stand-alone prescription drug plan (sometimes “PDP” is used to describe these), or whether your drug plan is part of your Medicare Advantage Plan (sometimes these drug plans are called an MA-PD”).
For one thing, you may get a notice that you are subject to a “late enrollment penalty.” (Medicare has a tendency to abbreviate everything; sometimes these are called “LEPs.”) That is, you may be told that, because you did not sign up for Part D at your first or earliest opportunity, you may owe a penalty which is added to your monthly Part D premium. But you may believe that this is incorrect. For example, you may have had “creditable” drug coverage with another insurance plan and you have now signed up for Part D as that plan ended or you want to augment its coverage. Or perhaps you were not properly notified that your drug coverage was not creditable. (By “creditable,” we mean drug coverage that is as good as Medicare’s; if you have drug coverage, your insurance plan is supposed to tell you every year whether or not it is “creditable.” If you have creditable coverage and then sign up for Part D, you are not supposed to be penalized for any month you had creditable coverage.) Or perhaps you have qualified for “extra help,” that is, the low income subsidy, in which case you do not owe any penalty.
You can appeal your late enrollment penalty if you believe it is incorrect. You do this by asking for a reconsideration of the decision. While you are not required to use it, a “Part D Late Enrollment Penalty Reconsideration Request Form” is very helpful to filing your request. You are supposed to get on with the notice of you late enrollment penalty, but if you didn’t, you can go to the Centers for Medicare & Medicaid Services website www.cms.hhs,gov and click on “Medicare,” then on “Prescription Drug Grievances and Appeals,” then on “Forms.” Go to the very bottom of that page; the form is “Appendix 15.” Follow the instructions it gives and send your appeal to Maximus – a company that Medicare has hired to make appeals at the address below, NOT the addresses on the form. Be sure to write your Medicare number on everything that you send, and make copies of everything. That company can be reached by calling toll free 1-877-456-5302 to discuss your late enrollment penalty appeal.
Maximus Federal Services
Medicare Part D QIC
P.O. Box 991
Victor NY 14564-0991
Tomorrow I'll blog about getting your new drug plan to pay for medicines it doesn't cover, etc.
For one thing, you may get a notice that you are subject to a “late enrollment penalty.” (Medicare has a tendency to abbreviate everything; sometimes these are called “LEPs.”) That is, you may be told that, because you did not sign up for Part D at your first or earliest opportunity, you may owe a penalty which is added to your monthly Part D premium. But you may believe that this is incorrect. For example, you may have had “creditable” drug coverage with another insurance plan and you have now signed up for Part D as that plan ended or you want to augment its coverage. Or perhaps you were not properly notified that your drug coverage was not creditable. (By “creditable,” we mean drug coverage that is as good as Medicare’s; if you have drug coverage, your insurance plan is supposed to tell you every year whether or not it is “creditable.” If you have creditable coverage and then sign up for Part D, you are not supposed to be penalized for any month you had creditable coverage.) Or perhaps you have qualified for “extra help,” that is, the low income subsidy, in which case you do not owe any penalty.
You can appeal your late enrollment penalty if you believe it is incorrect. You do this by asking for a reconsideration of the decision. While you are not required to use it, a “Part D Late Enrollment Penalty Reconsideration Request Form” is very helpful to filing your request. You are supposed to get on with the notice of you late enrollment penalty, but if you didn’t, you can go to the Centers for Medicare & Medicaid Services website www.cms.hhs,gov and click on “Medicare,” then on “Prescription Drug Grievances and Appeals,” then on “Forms.” Go to the very bottom of that page; the form is “Appendix 15.” Follow the instructions it gives and send your appeal to Maximus – a company that Medicare has hired to make appeals at the address below, NOT the addresses on the form. Be sure to write your Medicare number on everything that you send, and make copies of everything. That company can be reached by calling toll free 1-877-456-5302 to discuss your late enrollment penalty appeal.
Maximus Federal Services
Medicare Part D QIC
P.O. Box 991
Victor NY 14564-0991
Tomorrow I'll blog about getting your new drug plan to pay for medicines it doesn't cover, etc.
Sunday, January 9, 2011
2011 Part B Open Enrollment Period
Those beneficiaries (or potential beneficiaries) who do NOT have Part B, for whatever reason, can take advantage of the 2011 Open Enrollment Period to sign up for it. This period begins January 1, 2011 and goes through March 31, 2011. (Don’t confuse it with the new Annual Disenrollment Period, which ends February 14.) During these three months you can call Social Security at 1-800-772-1213 and enroll. Your Part B will begin on July 1, 2011. Some things you should consider include:
You will pay a base premium of $115.40 per month. Note that you will not get the lower premiums that most beneficiaries get by virtue of the fact that their Social Security payments have not received cost-of-living increases recently.
You are also subject to the late enrollment penalty. For each 12 months that you could have had but did not have Part B, you will pay a 10% penalty. So, for example, if you could have signed up for Part B when you turned 65, let’s say in March 2010, your penalty will be 10 percent (you did not have Medicare from March 2010 to and including June 2011, or a total of 16 months. Your monthly penalty is $11.50 (10% of $115.40) and your premium will be $126.90 per month. Months you were covered by an Employer Group Health Plan or were an international volunteer abroad are not penalized. (See page 11 of Managing Your Medicare for the details.) This is no limit to how high this penalty is, nor is it reduced, as is the Part A premium penalty, over time. (However, if you are currently a disabled beneficiary, it will revert to the base premium when you turn 65, and if you are a beneficiary for any reason and get end stage renal disease, it will also revert.)
If your “modified adjusted gross income” in 2009 exceeds $170,000 (if you filed joint) or $85,000 (if you filed individually), you will be subject to the Part B premium surcharge. These surcharges run from $46.10 to $253.70 a month! And these are in addition to any penalty you must pay. These are fully explained on page 19 of Managing Your Medicare. See also my posting of 11/15/10.
You may be in the other income boat – low income. If your monthly income is anywhere in the neighborhood of $1,239 for an individual or $1,660 for a couple or below (the limits are a little higher in Hawaii and Alaska) and you have few “resources” (which generally include cash, savings, bonds, stocks, IRAs, etc, but NOT your home, car, jewelry, household goods, etc., etc.) you should apply for a “Medicare Savings Program” which will pay your Part B premium and possibly your Part B deductible and coinsurances. The rules of what counts as income and what counts as resources are complicated, and even vary from state to state, so you should always think of applying for this. I and many other Medicare counselors are continually amazed by the beneficiaries we run across who are eligible for this but don’t have it! Your state’s Medicaid people run this program, so call them. If you need to know the right number, call 1-800-MEDICARE and they can give it to you.
You will be able to enroll in a Medicare Advantage Plan, that is, a Medicare managed care Plan, also called Part C. (You almost always have to have BOTH Part A and Part B to do so.) You will probably have to wait until the 2011 Annual Election Period (which begins October 15 and ends on December 7) to enroll, and your enrollment will be effective with January 1, 2012. You may be able to enroll sooner if one of the special election periods applies to you (see page 122 of Managing Your Medicare to learn more about these).
If you are 65 or more and this is the first time you ever enrolled in Part B, you will also get a Medigap open enrollment period. It begins July 1, when you get your Part B, and lasts for six full months, that is, until December 31, 2011. During this time you are have a guaranteed right of issue for any Medigap policy sold where you live. It will go into effect the month following the one in which you sign up for a policy, so don’t delay. Note that Medigap policies are also called Medicare supplement policies. And even if you are thinking of signing up for a Medicare Advantage Plan, which will begin January 1, you ought to think of getting a Medigap policy until then.
Finally, if you do enroll in Part B you know you will get it on July 1, so aggressively begin to schedule all applicable preventive and educational services beginning with that date, as these are all Part B services. It may take you months to schedule your “Welcome to Medicare” exam with your physician, so begin lining it up as soon as you enroll. Same for all the other preventive and educational services. And go over chapter 4 of Managing Your Medicare to see what else Part B covers. Perhaps you have put off some physical therapy that you really need, or some mental health services; line these up, too.
You will pay a base premium of $115.40 per month. Note that you will not get the lower premiums that most beneficiaries get by virtue of the fact that their Social Security payments have not received cost-of-living increases recently.
You are also subject to the late enrollment penalty. For each 12 months that you could have had but did not have Part B, you will pay a 10% penalty. So, for example, if you could have signed up for Part B when you turned 65, let’s say in March 2010, your penalty will be 10 percent (you did not have Medicare from March 2010 to and including June 2011, or a total of 16 months. Your monthly penalty is $11.50 (10% of $115.40) and your premium will be $126.90 per month. Months you were covered by an Employer Group Health Plan or were an international volunteer abroad are not penalized. (See page 11 of Managing Your Medicare for the details.) This is no limit to how high this penalty is, nor is it reduced, as is the Part A premium penalty, over time. (However, if you are currently a disabled beneficiary, it will revert to the base premium when you turn 65, and if you are a beneficiary for any reason and get end stage renal disease, it will also revert.)
If your “modified adjusted gross income” in 2009 exceeds $170,000 (if you filed joint) or $85,000 (if you filed individually), you will be subject to the Part B premium surcharge. These surcharges run from $46.10 to $253.70 a month! And these are in addition to any penalty you must pay. These are fully explained on page 19 of Managing Your Medicare. See also my posting of 11/15/10.
You may be in the other income boat – low income. If your monthly income is anywhere in the neighborhood of $1,239 for an individual or $1,660 for a couple or below (the limits are a little higher in Hawaii and Alaska) and you have few “resources” (which generally include cash, savings, bonds, stocks, IRAs, etc, but NOT your home, car, jewelry, household goods, etc., etc.) you should apply for a “Medicare Savings Program” which will pay your Part B premium and possibly your Part B deductible and coinsurances. The rules of what counts as income and what counts as resources are complicated, and even vary from state to state, so you should always think of applying for this. I and many other Medicare counselors are continually amazed by the beneficiaries we run across who are eligible for this but don’t have it! Your state’s Medicaid people run this program, so call them. If you need to know the right number, call 1-800-MEDICARE and they can give it to you.
You will be able to enroll in a Medicare Advantage Plan, that is, a Medicare managed care Plan, also called Part C. (You almost always have to have BOTH Part A and Part B to do so.) You will probably have to wait until the 2011 Annual Election Period (which begins October 15 and ends on December 7) to enroll, and your enrollment will be effective with January 1, 2012. You may be able to enroll sooner if one of the special election periods applies to you (see page 122 of Managing Your Medicare to learn more about these).
If you are 65 or more and this is the first time you ever enrolled in Part B, you will also get a Medigap open enrollment period. It begins July 1, when you get your Part B, and lasts for six full months, that is, until December 31, 2011. During this time you are have a guaranteed right of issue for any Medigap policy sold where you live. It will go into effect the month following the one in which you sign up for a policy, so don’t delay. Note that Medigap policies are also called Medicare supplement policies. And even if you are thinking of signing up for a Medicare Advantage Plan, which will begin January 1, you ought to think of getting a Medigap policy until then.
Finally, if you do enroll in Part B you know you will get it on July 1, so aggressively begin to schedule all applicable preventive and educational services beginning with that date, as these are all Part B services. It may take you months to schedule your “Welcome to Medicare” exam with your physician, so begin lining it up as soon as you enroll. Same for all the other preventive and educational services. And go over chapter 4 of Managing Your Medicare to see what else Part B covers. Perhaps you have put off some physical therapy that you really need, or some mental health services; line these up, too.
Thursday, January 6, 2011
Change in Annual Wellness Visit (AWV) Information - Advanced Directives
According to the New York Times reporter Robert Pear, the regulation that allowed Medicare to pay for voluntary discussions between doctors and beneficiaries about advanced directives (end-of-life care) during their newly inaugurated Annual Wellness Visit has been suspended. Apparently, this does NOT mean that you can’t discuss this with your physician during your visit, only that this part of the encounter with your physician isn’t an official part of the Medicare service. And while I have not found anything in the official Federal Register yet, it may be that the Centers for Medicare & Medicaid Services is thinking of proposing that this be a part of the service and will seek public discussion and comment on this apparently quite controversial matter. Unless I find out differently, it appears that this should not really change what goes on during such a visit, as this was always seen as voluntary.
Tuesday, January 4, 2011
Inauguration of the Annual Disenrollment Period and the
Inauguration of the Annual Disenrollment Period and the Elimination of the Open Enrollment Period
This applies only to Medicare beneficiaries who are now in a Medicare Advantage Plan.
The Medicare Advantage Open Enrollment Period, which has run from January 1 to March 31 of each year and which allowed you to make a variety of changes to how you got your Medicare, and which Plan you were in, is eliminated. It is no longer in effect.
In its place is a new Annual Disenrollment Period, which runs only from January 1 to February 14 of 2011 and every year thereafter. It is important to understand that this new period is less than half as long as the previous one, so you will have to act more quickly to make any permissible changes.
The changes you can make during this 45 day period are these: (Note that they are much more restrictive than what you could do in the now obsolete Medicare Advantage Open Enrollment Period.)
You may leave Medicare Advantage (Part C) and go to Original (fee-for-service) Medicare. The change will be effective first day of month following the date you disenroll from your Medicare Advantage Plan.
And, if you do so, you may join a stand-alone Part D drug plan. You will join this drug plan on first day of month following the date the plan gets your enrollment request. Note that you may enroll in a Part D plan whether or not the Medicare Advantage Plan you were in did or did not have Part D drug coverage.
And you do this either by:
Disenrolling from your Medicare Advantage Plan. This will put you in Original Medicare without any Part D drug coverage.
Or by enrolling in a stand-alone Part D drug plan. This will automatically disenroll you from your Medicare Advantage Plan and put you into Original Medicare and enroll you in the Part D drug plan.
And you may disenroll from your Medicare Advantage Plan and later enroll in a stand-alone Part D drug plan, as long as you enroll by February 14, 2011.
You may NOT join a Medicare Advantage Plan nor switch from one Medicare Advantage Plan to another.
So, in effect, during this Annual Disenrollment Period, a beneficiary in Medicare Advantage (Part C) who does not like their Plan and is willing to go back to Original Medicare (“fee-for-service” Medicare, also known as “plain vanilla” Medicare) may do so. Or, if for some reason, a beneficiary who is in such a Plan did not sign up for one with drug coverage, or did get it and now sees it as a bad choice of a Part D plan, may, if they are willing to go back to Original Medicare, can re-choose their Part D, as long as they choose a stand-alone Part D Plan. As all of these charge a premium (and not every Medicare Advantage Plan does, even if it has drug coverage), you need to think of that. And, of course, if you need or want a Medigap insurance policy (Medicare supplement), you better be sure you can get one (and price it to see if you can afford it) BEFORE you jump back into Original Medicare.
This applies only to Medicare beneficiaries who are now in a Medicare Advantage Plan.
The Medicare Advantage Open Enrollment Period, which has run from January 1 to March 31 of each year and which allowed you to make a variety of changes to how you got your Medicare, and which Plan you were in, is eliminated. It is no longer in effect.
In its place is a new Annual Disenrollment Period, which runs only from January 1 to February 14 of 2011 and every year thereafter. It is important to understand that this new period is less than half as long as the previous one, so you will have to act more quickly to make any permissible changes.
The changes you can make during this 45 day period are these: (Note that they are much more restrictive than what you could do in the now obsolete Medicare Advantage Open Enrollment Period.)
You may leave Medicare Advantage (Part C) and go to Original (fee-for-service) Medicare. The change will be effective first day of month following the date you disenroll from your Medicare Advantage Plan.
And, if you do so, you may join a stand-alone Part D drug plan. You will join this drug plan on first day of month following the date the plan gets your enrollment request. Note that you may enroll in a Part D plan whether or not the Medicare Advantage Plan you were in did or did not have Part D drug coverage.
And you do this either by:
Disenrolling from your Medicare Advantage Plan. This will put you in Original Medicare without any Part D drug coverage.
Or by enrolling in a stand-alone Part D drug plan. This will automatically disenroll you from your Medicare Advantage Plan and put you into Original Medicare and enroll you in the Part D drug plan.
And you may disenroll from your Medicare Advantage Plan and later enroll in a stand-alone Part D drug plan, as long as you enroll by February 14, 2011.
You may NOT join a Medicare Advantage Plan nor switch from one Medicare Advantage Plan to another.
So, in effect, during this Annual Disenrollment Period, a beneficiary in Medicare Advantage (Part C) who does not like their Plan and is willing to go back to Original Medicare (“fee-for-service” Medicare, also known as “plain vanilla” Medicare) may do so. Or, if for some reason, a beneficiary who is in such a Plan did not sign up for one with drug coverage, or did get it and now sees it as a bad choice of a Part D plan, may, if they are willing to go back to Original Medicare, can re-choose their Part D, as long as they choose a stand-alone Part D Plan. As all of these charge a premium (and not every Medicare Advantage Plan does, even if it has drug coverage), you need to think of that. And, of course, if you need or want a Medigap insurance policy (Medicare supplement), you better be sure you can get one (and price it to see if you can afford it) BEFORE you jump back into Original Medicare.
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