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Q&A: Answering Questions About Medicare Open Enrollment

Adrian Clark | Flickr

Medicare open enrollment, which runs through Dec. 7, gives beneficiaries an opportunity to review and change their health and prescription drug plans. On Wednesday, “St. Louis on the Air” host Don Marsh sat down with Julie Brookhart, public affairs specialist for the Kansas City regional office of the Centers for Medicare and Medicaid Services, to learn more about open enrollment.

Do I need to sign up for a new plan?

You don’t necessarily need to, Brookhart said, but open enrollment does provide an opportunity to compare plans.

“We know that a lot of the times when we go out and help beneficiaries do comparisons of their plans, they are usually finding a better plan that will save them money the next year,” Brookhart said. “We always say it is wise to compare and do a checkup, because you never know if you might find something that’s more cost effective.

“But we also want to stress that if Medicare beneficiaries are satisfied with their current coverage and it meets their needs, they don’t have to do anything at all.”

How can I compare plans?

For the web savvy, Brookhart recommended visiting medicare.gov. “It is an award-winning website because it has such ease for consumers to use it,” she said. The site will ask for some basic information and provide plan details.

Medicare beneficiaries also can call Medicare at 800-633-4227, or Missouri’s State Health Insurance Assistance Program at 800-390-3330.

“They help people for free. They’re unbiased and they’re trained to know the Medicare program,” Brookhart said of the state assistance program. “They will set up an appointment with you to go over your choices for next year.”

I got a letter that said my 2014 plan has ended. What should I do?

In the St. Louis area, about 2,800 people are in Medicare Advantage plans that will not be available in 2015. Those affected by the change should have received a letter from the Centers for Medicare and Medicare Services by Oct. 2, Brookhart said. Beneficiaries in one of those plans have a little longer to make changes.

“For those that are in nonrenewing plans, they’ll have until Feb. 29th to make a change,” she said. “But if they do not do anything by Jan. 1st — because those plans will end by Dec. 31st — then if you do not do anything, you will automatically revert to original Medicare. You will always be covered by Medicare and have a health plan if you are in a nonrenewing plan.”

It is possible, however, to lose prescription coverage during the switch from a nonrenewing plan to original Medicare.

Anyone with questions about a nonrenewing plan, or to compare to current plans, should call Missouri’s State Health Insurance Assistance Program at 800-390-3330.

I already changed my Medicare plan, but I want to change it again. Can I?

Yes. “You can change your plan as many times as you want to up until the end of open enrollment,” Brookhart said. Open enrollment ends on Dec. 7. “The system is always going to kick out the old plan and you’ll be left with the last plan that you choose.”

Anyone who enrolls in a Medicare Advantage plan also has a little additional time to make adjustments if they find the plan is not working for them. Changes can be made between Jan. 1 and Feb. 15.

“Basically, what that’s for, it’s giving folks who made a choice into a Medicare Advantage plan — maybe they’ve never been in one before; they don’t know how it works; maybe they were talked into it by a health insurance company and they weren’t sure that they had to see certain doctors — that’s called the Medicare Advantage open enrollment period,” Brookhart said. Changes during that period are limited to those who enrolled in a Medicare Advantage plan by Dec. 7.

I just turned (or am about to turn) 65. Should I be enrolling in Medicare now?

“If you’re just turning 65, you have a seven month window to enroll in Medicare,” Brookhart said. “You have the three months before your 65th birthday, the month of your 65th birthday and then three months after.

“If you choose to have original Medicare, you might also want to look at Medigap policies as well,” she said. A Medigap policy is sold by private companies and can help pay some costs that original Medicare doesn’t cover, such as co-payments.

For more information on signing up for Medicare and on Medigap policies, contact Missouri’s health insurance assistance program at 800-390-3330.

Is there any additional help for those with a low income?

Low-income Medicare beneficiaries can apply for a subsidy for help paying out-of-pocket expenses with prescription drug coverage, Brookhart said. The Social Security Administration manages the income-based program. To see if you qualify, call 800-772-1213 or visit socialsecurity.gov and apply for the Extra Help With Medicare Prescription Drug Plan Costs program.

The St. Louis Better Business Bureau has issued a Medicare fraud warning. Should I be worried?

At least aware, yes. The Missouri Department of Insurance has warned seniors to be alert for scams related to Medicare.

“One of the most common ploys is someone posing as an employee from the Centers for Medicare and Medicaid Services or Social Security (Administration), saying that they need to have their Medicare card updated and to do so they need to verify your Medicare card number and maybe even your bank account number,” Brookhart said.

“Medicare is never going to call and ask for your Medicare information,” she said. Report potential Medicare fraud at 800-633-4227.

How has the Affordable Care Act changed or influenced Medicare?

“Thanks to the law, more people with Medicare are seeing reduced costs through discounts on their brand-name and generic drugs,” Brookhart said. “This is when they enter the doughnut hole or the coverage gap in their Medicare prescription drug plan.”

All Medicare prescription drug plans have a coverage gap: There is a temporary limit on what the drug plan will cover. In 2014, the gap kicked in after $2,850 was spent on covered drugs; in 2015, it will be $2,960.

“Before the ACA law, beneficiaries were then responsible for 100 percent of your drug costs, brand-name and generic drugs, which is quite a bit of money for someone on a limited income,” Brookhart said. “It was written into the law that seniors would get a reduced cost in the coverage gap.”

In 2015, seniors in the coverage gap will pay 45 percent of the cost for covered brand-name prescription drugs and 65 percent of the cost for covered generic drugs.

“By the year 2020, that should all be reduced to a beneficiary paying no more than 25 percent of the cost of their drugs,” Brookhart said.

Costs for most health screenings and preventative care also have been eliminated under the health care law, Brookhart said.

“St. Louis on the Air” discusses issues and concerns facing the St. Louis area. The show is produced by Mary Edwards and Alex Heuer and hosted by veteran journalist Don Marsh. Follow us on Twitter: @STLonAir.

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