Medicare Advantage Open Enrollment Runs Jan. 1 to Mar. 31
Medicare Advantage Open Enrollment allows people on Medicare to make a single plan election into or out of a Medicare Advantage Plan. Beneficiaries should carefully evaluate their plan options, not be pressured into making a quick decision and be on the look out for misleading sales pitches and promises that seem too good to be true.
Beneficiaries can contact the Western Regional SHINE Program with any questions, and help in determining a plan most suitable for their budget and healthcare needs, and to report any concerns regarding sales practices by companies and agents.
Here are the different coverage scenarios permitted during Medicare Advantage Open Enrollment:
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If a person on Medicare currently has coverage in a Medicare Advantage Plan with prescription drug coverage, they can use open enrollment to select a different Medicare Advantage Plan with prescription drug coverage, Original Medicare and a stand-alone prescription drug plan, or a Medicare Advantage Private-Fee-For-Service Plan and a stand-alone prescription drug plan.
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If a person on Medicare currently has coverage in a Medicare Advantage Plan with no prescription drug coverage, they can use open enrollment to select a Medicare Advantage Plan or Original Medicare without prescription drug coverage.
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If a person on Medicare currently has coverage in Original Medicare with a stand-alone prescription drug plan, they can use open enrollment to select a Medicare Advantage Plan with prescription drug coverage or a Medicare Advantage Private-Fee-For-Service Plan with the same stand-alone prescription drug plan.
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If a person on Medicare currently has coverage in Original Medicare without a stand-alone prescription drug plan, they can use open enrollment to select a Medicare Advantage Plan without prescription drug coverage.
There are numerous Medicare Advantage Plan choices, and they include managed care options like Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) and non-managed care options such as Private Fee For Service (PFFS) Plans and Medical Savings Accounts. Medicare Advantage Plans provide comprehensive health benefits and can include prescription drug coverage.
Here are a few consumer tips to help you avoid predatory sales practices that may be associated with the sale of Medicare coverage:
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Do not provide any personal information, such as your name or social security number, to anyone unless you are certain you will make a purchase.
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You do not need to use an agent to obtain Medicare Advantage or Medicare Part D coverage. For information on coverage, contact the Regional SHINE Program at 800-732-4636.
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Agents receive a commission for each policy they sell, so some agents may try to get you to switch plans even if it's not in your best interest.
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Be wary of agents who sell Medicare products door-to-door and agents who claim to work for Medicare. Medicare representatives do not enroll beneficiaries by making house calls.
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While you may qualify for a subsidy, in order to enroll in Medicare Advantage or Medicare Part D, you may be required to pay premiums that exceed the subsidy.
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Do not sign paperwork until you've had the opportunity to have a family member or trusted advisor confirm the product meets your needs.
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Contact your healthcare provider to verify they are a participating Medicare provider or accept the plan you are considering.
If you think you need to change your current plan and meet the above criteria, call the Regional SHINE program at 413-773-5555 or 978-544-2259 to speak to a counselor and/or to set up an appointment. We can help review your plan options, including cost effectiveness and least restrictive plans based on your current needs and medicines.
The SHINE, Serving Health Information Needs of Elders Program, provides free, confidential and unbiased health insurance counseling for Medicare beneficiaries. To reach a trained and certified counselor in your area, contact the Regional Office at 1-800-498-4232 or 413-773-5555 or contact your local Council on Aging.