This is the time of year to review your Medicare and Affordable Care Act coverage to make sure it meets your health care needs, especially if you are currently or plan to get treatment for hepatitis B.
By Jacques Chambers
Open Enrollment starts Oct. 15 and ends Dec. 7. All changes made during this time are effective Jan. 1, 2016.
Affordable Care Act
Open Enrollment runs from Nov. 1 through Jan. 31, 2016. The effective date will be based on when the changes are requested;
- If made on or before 12/15/2015 – Changes effective on January 1, 2016;
- If made 12/16/2015 through 01/15/2016 – Changes effective on February 1, 2016;
- If made 01/16/2016 through 01/31/2016 – Changes effective on March 1, 2016
Employer-Provided Benefit Programs also frequently provide an Open Enrollment Period for employees, allowing them to make changes in their employee benefits choices. Although employers can select other times of the year, most employers who offer one have their Open Enrollment in November and/or December for a January 1, 2016 effective date.
Medicare beneficiaries have the opportunity to switch their coverage from any to any of several choices:
Original Fee For Service Medicare – Parts A and B of original Medicare are the same for everyone; however, each beneficiary can elect the prescription drug plan in which to enroll. The best way to do this is to compare plans using your own current prescriptions, since your medications may have changed and plan formularies and prices also change.
There is a program on line at www.medicare.gov that allows you to enter your medications, which pharmacy your prefer, and where you live; it will then show you what each plan would cost you out of your pocket based on your medications. Click on “Find Health and Drug Plans” and follow from there. I recommend the “General Search” rather than the personal one; it is much quicker and just as accurate. If you are on particularly expensive medications, once you find a drug plan, you should confirm the coverage and what you will pay directly with the insurance company as errors sometimes occur.
Even if your current Drug Plan has been serving you well, it is still advisable to run the program. The plans for 2016 are already up on the website.
For persons who are not comfortable with computers, Medicare’s toll-free number (800-MEDICARE) will do the same calculation. However, I recommend you find a friend or relative who will do it for you on a computer because the results are too long and involved for a telephone operator to spend much time reviewing the options based on your specific needs.
Medicare Supplement (also called Medigap) Plans – This open enrollment period does NOT apply to the Medigap Plans sold to people with Original Medicare to “fill the coverage gaps” left by Medicare Parts A & B. To find out when you can purchase them, go to www.medicare.govand search for “When Can I Buy a Medigap Policy”. It will list the Open Enrollment opportunities for them. They may also be purchased at other times, but the insurance company may require proof of good health.
Medicare Advantage Plans – These are plans offered by insurance companies and health service providers and are an alternative to Fee-for-Service Medicare. Many of these plans are run by Health Maintenance Organizations (HMOs), but there are also Preferred Provider Organization Plans (PPOs), Exclusive Provider Organizations (EPOs), Special Needs Programs, and Private Fee-For-Service plans, although all types are not available in all areas. All Medicare Advantage Plan must offer all of regular Medicare’s benefits and may add more. Some plans may also charge an additional premium, usually relatively small. These plans frequently include the prescription drug coverage in their plan so you don’t have additional task of finding a Part D drug plan.
During this Open Enrollment Period, persons may switch from one Medicare Advantage Plan to another or move back to or away from Fee-For Service Medicare.
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