| Annual/Open Enrollment information |
 |
|
 |
| Dates and benefit changes seniors need to know about |
|
If you're a senior who relies on Medicare for your health care needs, you should be aware of changes this year that will affect your benefits. As with every enrollment season, there are important things you should watch out for and consider when evaluating your coverage needs.
The Senior Health Insurance Benefits Assistance Program (SHIBA) is here to help you consider your options.
Click here for a printable pdf of the information on this page.
Click here for a printable pdf (or you can simply view it online) of the 2012 Oregon Guide to Medigap, Medicare Advantage, and Prescription Drug Plans.
|  |
|
| Enrollment information and other improvements |
|
New in 2012: 5-star SEP
There’s a new Part D and Medicare Advantage Special Enrollment Period (SEP) set to begin for the 2012 plan year that’s associated with the current star-rating system of Medicare Advantage and Part D plans. You can find a plan’s star-rating in the Medicare Plan Finder tool, under the Plan Details or Plan Comparison pages. You may consider a plan’s overall rating as one of many factors when reviewing and comparing your plan options.
How does the star-rating system relate to having a SEP?
The Affordable Care Act (ACA) directs use of this star-rating system to offer incentives including awarding bonus payments to Medicare Advantage plans that provide better quality care of services to their members. Prescription Drug Plans will not receive incentive awards.
What is the new SEP?
People with Medicare Parts A and B can use this new 5-star SEP from Dec. 8 through to Nov. 30, of the next year, to enroll in any 5-star plan including:
- A 5-star Medicare Advantage (MA-only) plan,
- A 5-star Medicare Advantage plan with prescription drug coverage (MA-PD), or
- A 5-star Prescription Drug Plan (PDP).
Once you enroll in a 5-star plan using this SEP, your SEP ends for that plan year and you will be limited to making changes only during other applicable enrollment periods. Coverage with the new 5-star plan takes effect the first of the month following your enrollment.
Note: The frequency that SEP may be used — You get only one election per calendar year with the 5-star SEP. This means for the 2012 plan year you can use the SEP only once between Dec. 8, 2011 and Nov. 30, 2012. Once you use it to enroll in a 5-star plan, you must remain in that plan – unless you have another SEP – through the plan year. (References: National Council on Aging October 2011 newsletter and Centers for Medicare and Medicaid Services (CMS) Medicare Managed Care Manual, Section 30.4.4 SEPs for Exceptional Conditions, #15, SEP to Enroll in an MA Plan or PDP With a Plan Performance Rating of Five (5) (pages 43-44) for explanation of 5-star SEP and allowable changes.)
Annual Disenrollment Period
Jan. 1 to Feb. 14 is the Medicare Advantage Disenrollment Period (ADP). The purpose of this period is to allow current Medicare Advantage enrollees to switch to Original Medicare if they do not feel they made a good Medicare Advantage Plan enrollment decision between Oct. 15 and Dec. 7. If you choose to switch to Original Medicare during this period you can also enroll in a Medicare Prescription Drug plan. Additionally, you may be able to enroll in a Medicare Supplement plan, however, you may be subject to medical underwriting.
Beginning in 2011, Open Enrollment for Medicare Part D and Medicare Advantage Plans is Oct. 15 through Dec. 7. The Affordable Care Act changed the enrollment period to provide one extra week to compare plans and enough time to ensure that any changes made will be in place by January 2012 for seamless and uninterrupted access to healthcare providers and medications at chosen pharmacies.Note: If you have questions about your enrollment options please contact SHIBA at 1-800-722-4134. For 24 hours a day 7 days a week assistance you may contact a Medicare customer service representative at 1-800 MEDICARE (633-4227).
Patient Protection and Affordable Care Act (PPACA) Changes
The PPACA was signed into law in March 2010. The health care overhaul law made a number of improvements to Medicare.
Improvements to Original Medicare
Preventive care: Medicare beneficiaries now receive free preventive services including diabetes screening, mammograms, some vaccines and colorectal cancer screenings.Annual physical exams: Beneficiaries are now eligible for a yearly wellness exam to develop or update a personalized prevention plan.
Medicare Prescription Drug Coverage
Some beneficiaries enrolled in Medicare Prescription Drug plans face a gap in coverage often referred to as the doughnut hole. This is the portion of your annual drug expenditures, when you may be responsible for the costs of all medications. Some beneficiaries who enter the doughnut hole will get a 50% (stays the same in 2012) discount on Medicare-covered brand name drugs and a 14% discount (in 2012) on Medicare-covered generic prescriptions while in the "doughnut hole."
Medicare Advantage Plans
Medicare Advantage plans cannot charge you more than traditional Medicare for chemotherapy, dialysis, skilled nursing care, and other services deemed appropriate. Check with your plan to see if preventive care and wellness improvements to Original Medicare will be available to you.
Non-renewal Notices
Every year, some Medicare Advantage and Medicare prescription drug plans choose not to renew their Medicare contracts. If you received a non-renewal notice this year, the notice should also have included information about the options available in your area.When weighing your options, compare coverage and costs to find the policy that best fits your health care needs. Remember, new Medicare Advantage plans could have different coverage limits, participating doctors and prescription drug lists than your current plan. If you choose Original Medicare, you might want to consider a prescription drug policy and/or a Medicare supplement insurance policy to augment your coverage.
Marketing Rules
State and federal rules are in place to protect you against abuses in the marketing and sales of Medicare prescription drug plans and Medicare Advantage plans. Individuals who contact you about any type of private Medicare coverage:
- Must be licensed by the state. Check the Oregon Insurance Division website to make sure the salesperson is a licensed agent at http://www.oregoninsurance.org/producer/agent.html.
- May not make unsolicited contact such as door-to-door sales, cold calls or approaching you in a parking lot.
- Must have an appointment to come to your home.
- Must arrange in advance the type of products that will be discussed during a scheduled sales appointment. At the appointment, the salesperson may not try to sell you other types of insurance coverage other than the type(s) agreed upon in advance.
- May not try to sell you non-health care related products (like a life insurance policy or an annuity) during a sales or marketing presentation of a Medicare prescription drug or Medicare Advantage plan.
- May not attempt to sell you a plan in certain health care settings, such as a doctors office or a pharmacy.
- May not attempt to sell you a plan at an educational event.
- May not offer you free meals at promotional or sales events.
- May not offer you gifts or other promotional items whose value exceeds $15.
Medicare Fraud
Unfortunately, not everyone who contacts you about switching Medicare plans has the best intentions. To protect yourself from scams, here are some additional tips: - Beware of door-to-door salespeople. Agents cannot solicit business at your home without an appointment. Do not allow uninvited agents into your home.
- Do not give out personal information, such as Social Security, bank account or credit card numbers to anyone you have not verified as a licensed agent. Agents are not allowed to request such personal information in their marketing activities and cannot ask for payment over the Internet. They must send you a bill. Once you decide to purchase a plan and have verified that the agent is licensed, you may give the agent personal information to assist in enrollment and billing.
- Verify that the plan you have chosen is an approved Medicare plan. All of the approved plans are available at www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227).
- If you suspect Medicare fraud you can report it locally to Oregon's SHIBA program at 1-800-722-4134 or the Senior Medicare Patrol (SMP) program at 1-888-372-8301.
Other Important Considerations
Federal assistance with premiums is available to Medicare beneficiaries who meet certain income requirements. If you think you may qualify, call the Social Security Administration at 1-800-SSA-1213 (1-800-772-1213).
Medicare beneficiaries may seek assistance in reviewing options for coverage and obtaining financial assistance information by contacting their State Health Insurance Assistance Program (SHIP) known in Oregon as SHIBA, 1-800-722-4134.
|
|
|
|
