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Medicare Open Enrollment
October 15 - December 7

Understanding Medicare Open Enrollment

Medicare’s Open Enrollment Period is the time of year when you can make changes to your Medicare coverage. Medicare’s Open Enrollment runs from October 15 through December 7, and any changes you make will take effect on January 1, 2020.

Point 1:Know the changes you can make during Medicare’s Open Enrollment Period.

During Medicare’s Open Enrollment Period, you can make changes to your health insurance coverage, including adding, dropping, or changing how you receive your Medicare benefits. You can make as many changes as you want during this period, but only your last coverage choice will take effect in January. 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, and switching from a Medicare Advantage Plan to Original Medicare.

Before making a decision about your 2020 coverage, consider the Medicare health and drug plan options in your area. You may be able to receive better health and/or drug coverage at a more affordable price. For example, even if you are satisfied with your current Medicare Advantage or Part D plan, you should check to see if there is another plan in your area that covers your health care and/or drugs at a better price.

Point 2: Review your current Medicare health and drug coverage.

You receive a lot of mail during Medicare’s Open Enrollment Period, so it is important to know which mailings include information about your current coverage. No matter how you receive your Medicare coverage, you should consider your access to health care providers and pharmacies you want to use, your access to benefits and services you need, and the total costs for insurance premiums, deductibles, and cost-sharing amounts.

If you have Original Medicare, visit Medicare.gov or read the 2020 Medicare & You handbook to learn about Original Medicare benefits for 2020.

If you have a Medicare Advantage Plan or a stand-alone Part D plan, read your plan’s Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC). These notices list any changes for your plan in 2020. Pay special attention to any changes in A) the plan’s costs, B) the plan’s benefits and coverage rules, and C) the plan’s formulary. A formulary is a list of drugs your plan covers. Make sure that your drugs will still be covered next year and that your providers and pharmacies are still in the plan’s network. If you are unhappy with any of your plan’s changes, you can change plans.

Point 3: Protect yourself from marketing violations.

During Medicare’s Open Enrollment Period, 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 and email, but are not allowed to call 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. Before you enroll in a plan, make sure you understand what the plan covers and whether it covers the drugs you need. Contact a plan directly to learn about the services it covers and get everything in writing.

Source: shiptacenter.org

The following enrollment period changes took effect in 2019:

  • If you have a Medicare Advantage Plan, you are able to change your coverage between January 1 and March 31. During this time, you can switch from one Medicare Advantage Plan to another, or switch from a Medicare Advantage Plan to Original Medicare, with or without a Part D prescription drug plan. If you are enrolled in Original Medicare, you will not be able to make changes during this time.
  • If you have Extra Help to pay for prescription drugs, you are no longer be able to change plans once per month. Instead, you will have a Special Enrollment Period to enroll in or switch Part D plans once per quarter in the first three quarters of the year. The quarters are January through March, April through June, and July through September. If you make a change, your new coverage will begin the first day of the month following the month when you enroll.

To enroll in a new plan, you can call 1-800-MEDICARE, use the Medicare Plan Finder tool, call the plan directly, or receive unbiased assistance from a certified GeorgiaCares counselor at 1-866-552-4464 (Option 4).

What to do During Medicare Open Enrollment

  1. Review your plan notice. Be sure to read any notices from your Medicare plan about changes for next year, especially your “Annual Notice of Change” letter. Look at your plan’s information to make sure your drugs are still covered and your doctors are still in network. 
  2. Think about what matters most to you. Medicare health and drug plans change each year and so can your health needs. Do you need a new primary care doctor? Does your network include the specialist you want for an upcoming surgery? Is your new medication covered by your current plan? Does another plan offer the same value at a lower cost? Take stock of your health status and determine if you need to make a change. 
  3. Find out if you qualify for help paying for your Medicare. Learn about programs in Georgia to help with the costs of Medicare premiums, your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) deductibles, coinsurance and copayments and Medicare prescription drug coverage costs. You can do this by visiting Medicare.gov or the Georgia Division of Families and Children Services to apply.
  4. Shop for plans that meet your needs and fit your budget. Starting in October, you can use the Medicare Plan Finder tool to see what other plans are offered in your area. A new plan may: 
    • Cost less
    • Cover your drugs
    • Let you go to the providers you want, like your doctor or pharmacy
    If you find that your current coverage still meets your needs, then you’re done. Remember, during Medicare Open Enrollment, you can decide to stay in Original Medicare or join a Medicare Advantage Plan. If you’re already in a Medicare Advantage Plan, you can switch back to Original Medicare.
  5. Check your plan's star rating before you enroll. The Medicare Plan Finder has been updated with the 2020 Star Ratings for Medicare health and prescription drug plans. Plans are given an overall quality rating on a 1 to 5 star scale, with 1 star representing poor performance and 5 stars representing excellent performance. Use the Star Ratings to compare the quality of health and drug plans being offered.
Source: www.cms.gov

Consider These 6 Things When Choosing Coverage

  • Costs: How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.
  • Coverage: How well does the plan cover the services you need?
  • Your other coverage: If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator or insurer before making any changes.
  • Prescription drugs: What's the plan’s overall star rating? What will your prescription drugs cost under each plan? Are your drugs covered under the plan's formulary? Are there any coverage rules that apply to your prescriptions? Are you eligible for a free Medication Therapy Management (MTM) program?
  • Doctor and hospital choice: Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network? Do you need to get referrals?
  • Quality of care: Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services? Get help comparing plans and providers.

Preventing Fraud During Medicare Open Enrollment

Medicare fraud is a year-round problem. Medicare Open Enrollment provides additional opportunities for identity thieves and scammers to take advantage of beneficiaries. 

You can protect your identity and help prevent health care fraud by guarding your Medicare card like you would a credit card. Identity theft from stolen Medicare Numbers is becoming more common. To help fight fraud, Medicare has removed Social Security Numbers from Medicare cards and replaced them with a new, unique number for each person with Medicare. Medicare mailed the Medicare cards with the new numbers between April 2018 and April 2019. If you have not received your new card, contact the Social Security Administration to verify your mailing address.

Here are some important steps you can take to protect yourself from the identity theft that can lead to health care fraud:

  • Don’t share your Medicare Number with anyone who contacts you by telephone, email or in person, unless you’ve given them permission in advance. Medicare will NEVER contact you (unless you ask us to) for your Medicare Number or other personal information.
  • Don’t ever let anyone borrow or pay to use your Medicare Number.
  • Review your Medicare Summary Notice to be sure you and Medicare are only being charged for   actual items and services received.

If you’re looking to enroll in a Medicare plan:

  • Remember there are no “early bird discounts” or “limited time offers.”
  • Don’t let anyone rush you to enroll by claiming you need to “act now for the best deal.”
  • Be skeptical of free gifts, free medical services, discount packages or any offer that sounds “too good to be true.”

Source: www.cms.gov

Rules for Medicare Health Plans and Insurance Agents  
All Medicare Advantage and Part D plans must follow strict marketing rules. Here are some  tips on what plans can and cannot do.
  Think you’ve spotted a scam?
Report it to the FTC. If the scam is Medicare related, report it at Medicare.gov

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