The Annual Election Period (AEP) is right around the corner, as it begins on October 15th and continues through December 7th. For those enrolled in Medicare, both Part A Hospital and Part B Medical, this is a time that you can make changes and/or additions.
For example, if you are unhappy with your current Medicare Advantage Plan or your Prescription Drug Plan (PDP), our friendly licensed agents at CA Medicare, can help you change your insurance carrier to help you save time and money.
On the other hand, if you are currently only enrolled in an Original Medicare plan or an Original Medicare and Supplement plan, this would be the time that you can switch to a Medicare Advantage Plan.
At CA Medicare, we can help you make these changes and also help you get the best insurance plan for you needs.
Below, we’ve provided you with an amazing resource, our AEP Enrollment Checklist. Use this checklist as a guide to help you and then call us today at 1-800-356-3615 for a free quote.
Here are the changes you can make during AEP:
- Switch from Original Medicare to a Medicare Advantage Plan
- Switch from a Medicare Advantage plan back to Original Medicare
- Switch from a Medicare Advantage Plan that doesn’t’ include drug coverage to one that does, and vice versa
- Join a Medicare prescription drug plan
- Switch from one Medicare prescription drug plan to another one
- Drop your Medicare prescription drug coverage
You might be wondering if you can make changes after December 7th:
Between January 1-February 14, if you’re in a Medicare Advantage Plan, you leave that plan and switch to Original Medicare. If you switch to Original Medicare during this period, you’ll have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage.
*Note: Your coverage will begin the first day of the month after the plan gets the enrollment request.
During this time, you cannot:
- Switch from Original Medicare to Medicare Advantage Plan
- Switch from One Medicare Advantage Plan to another
- Switch from one Medicare Prescription Drug Plan to another
- Join, switch, or drop a Medicare Medical Savings Account Plan
To begin, start by taking a look at the checklist below:
- Are you eligible to enroll?
If you are thinking about joining a Medicare Advantage plan, verify your eligibility first. To join a Medicare Advantage plan, you must have Medicare Part A and Part B and live in the service area of the Medicare Advantage plan you’d like to join.
*Note: If you have an end-stage renal disease (ESRD), you typically cannot join a MAP, but there are exceptions.
If you have a Medicare Advantage Plan and enroll in Prescription Drug Plan (PDP), you will be automatically disenrolled from the Medicare Advantage Plan
- Does your current coverage still meet your needs?
Take a look at your current Medicare coverage before AEP and carefully review if it still meets your healthcare needs.
The first thing you would have received is the annual Change of Notice, which would have been in your hand by September 30th. The annual Change of Notice lays out the changes of your plan from 2016 to 2017. You should be receiving the Evidence of Coverage soon. The EOC details all of your plan benefits. You will also be receiving a Prescription Drug Formulary, which lists all the coverage drugs. More information below on what you need to know regarding the Prescription Drug Formulary.
Medicare Advantage Plans vary in specific benefits, but all are required to offer at least the same amount of coverage as Original Medicare. Many plans offer additional benefits such as hearing aids, transportation, dental, vision, and gym memberships. Often you can go beyond a basic built in dental and vision to something more substantial by adding Optional Supplemental Benefits (OSB’s). Dental/Vision packages usually range from $12-$37 per month. To note, Prescription Drug coverage, is not included in Original Medicare and must always be obtained separately. You can either receive it as a stand-alone as a Part D prescription drug plan or a Medicare Advantage Plan that includes drug coverage known as a Medicare Advantage Prescription Drug Plan.
After taking a look at your Prescription Drug Formulary, please confirm that your drugs are still listed, if not, they’re not covered. If they are, confirm that the Coverage Tier hasn’t changed. For example, if you are taking a brand name drug that was tier 3 and was downgraded to a tier 4, your co-pay could double. Every year carriers change their formularies It doesn’t make any sense to choose a Medicare Advantage Prescription Drug Plan that has a slightly lower doctor copay to be on the hook for a $200 a month name brand drug. Rerun your drugs with all of the different MAPD plans to see what is best for you. At CA Medicare, we can prepare a drug report for your convenience.
To note, almost all Medicare Advantage Plans are HMO. For the first time in years a PPO Medicare Advantage Plan is available in Los Angeles, Riverside and San Bernardino Counties. The great thing about a PPO is the network is larger and you don’t need a referral to see a specialist. If you are willing to pay more, you can also go out of network as well.
HMO plans are generally free, depending on what county you live in. PPO plans are not available in most counties. Most counties do not offer PPO plans, even if you want to pay for them, they may not be available. Check to see if you a PPO plan is offered in your county
You might think that everything is great with your Medicare Advantage Plan, because you don’t have a premium or office visit co pay. Different Medicare advantage plans have different maximum amount of pockets. For example, most plans require you to pay 20% co-insurance for radiation treatment for cancer and you keep paying this till you reach your maximum amount of out of pocket. Depending on your plan and county, your maximum amount of out of pocket could be anywhere as low as 2000 dollars to well more than 6000 dollars. When reviewing your documents, take into consideration of these changes and your maximum amount of out of pocket before it is too late.
- Find out how joining a Medicare plan may affect your other insurance.
For some cases, if you are a retiree or receive veterans’ benefits, you may want to check to see if that insurance covers services that Medicare does not. Call us at 1-800-356-3615 to receive a free quote and discuss how we can help you find the best health insurance plan for your needs.
In some cases, you may be required to receive Medicare to maintain eligibility. However, in some other cases, enrollment into a MAPD or Medicare Prescription drug plan may cause you to irreversibly lose your other coverage.
- Find the best price for your coverage
Of course, at this point, you might be thinking, how much is it going to cost? At CA Medicare, we can help you find the best health insurance plan for your needs to help you save time and money
Take in the mind of the following when shopping for a plan. You may also consider to speak with a licensed agent at CA Medicare to help you find the best plan to save you time and money.
- Provider Networks – If there are certain doctors you’d like to keep, make sure they are part of the network of your Medicare Advantage HMO. Please note with a MAPD HMO, your specialist must be part of the same medical group as your primary care physician (PCP) in order to obtain a referral. Only Emergency services are covered out of network with a MAPD HMO. On the other hand, if you have a MAPD PPO, you’ll have a larger network to choose from, without the necessity of obtaining a referral to see specialist.
- Prescription Medications – Check to see if your current prescription drug medications are listed on the formulary, and if so, confirm that the Tier hasn’t increased (Tier 3 to Tier 4 etc.)
- Total cost-sharing expenses – Not just the premium, when comparing plans, but the cost-sharing expenses as a whole.
- Ratings –Medicare Prescription Drug plans and Medicare Advantage plans are rated on a scale of 1 to 5 for quality and customer satisfaction.
At CA Medicare, we can prepare a custom drug report for you and help you find a doctor and plan for your needs in your network.
We hope you’ve enjoyed our checklist and are ready to make a change to help you get the best health insurance plan for your health and wellness. Call us today and make the change at CA Medicare. Our licensed agents will be happy to help you and will save you time and money! Call today at 1-800-356-3615.