Medicare Enrollment Periods – Do You Know the Difference?

More than 58 million people in the United States are enrolled in Medicare. But there is still medicare
a significant amount of confusion about how and when to make Medicare coverage choices. For information about the basics of Medicare and its different parts of coverage, read our Quick Guide to Medicare.

There are 4 separate enrollment periods that are important to getting access to Medicare coverage.

  1. The initial enrollment period happens once – when you are first eligible for
    Medicare. And, generally, it lasts 7 months (the 3 months before your 65th birthday, the month of your 65th birthday, and 3 months after your 65th birthday). If you are eligible for Medicare because you have received SSDI benefits for 24 months, your Medicare will begin in your 25th month of receiving SSDI benefits.
  1. And, each year, from October 15 to December 7, you can make changes to your Medicare coverage, which will begin on January 1. This is called the open enrollment period.
  1. If you are over the age of 65, but are still working, you have a special enrollment period of 8 months after your employer-sponsor group health plan or your retirement plan coverage ends.
  1. And finally, if you do not sign up for Medicare when you are first eligible during your initial enrollment period or your special enrollment period, then you can still enroll in Medicare, but you have to wait until the general enrollment period. The general enrollment period occurs each year from January 1 to March 31. Individuals can sign up for Part A and B during this time frame. Once enrolled in Part A and Part B, between April 1 and June 30, individuals can add a Part D plan or move to a Part C plan. However, even if you sign up for coverage on the first day of the general enrollment period, you still have to wait until July 1, for your coverage to begin.

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And, because you didn’t sign up for Medicare when you were first eligible, you will likely have to pay a late enrollment penalty:

  • Part A: you must pay a 10% penalty for twice the number of years you were eligible, but didn’t sign up.
  • Part B: you must pay a 10% penalty for each full 12-month period you were eligible, but didn’t sign up. You must pay this penalty on your Part B premium for life!
  • Part D: you must pay a penalty of 1% of the national base monthly premium, times the number of full months you were eligible, but didn’t sign up. You must pay this penalty on your Part D premium for life!

Part B Penalty Example:

David’s initial enrollment period ended August 31, 2015, but waited to sign up for Part B until the general enrollment period in February 2018. David waited 30 months to sign up, but this only included 2 full 12-month periods. (2 full 12-month periods x 10% = 20% penalty). David will pay a 20% penalty, in addition to his monthly Part B premium, for life!

Waiting to enroll in Medicare coverage can cost you a lot over time, so it is important to understand your options. For more information about Medicare enrollment and penalties, visit www.medicare.gov

How States are Changing Health Insurance Rules

In an ongoing effort to keep you up to date on the many proposed and approvedhealth insurance
changes to our health care system and how they might impact the cancer community, this week, we bring you updates from around the country. If you don’t live in one of these states, be aware, these changes could come to your state next.

National News:

Two weeks ago, we reported that 11 states have applied for waivers to make some individuals work, in order to get access to health care through Medicaid. Since then, Kentucky and Indiana’s waivers have already been approved by the Center for Medicare and Medicaid Services and those states are moving forward with implementing plans for a Medicaid work requirement. Click here to learn more about the impact of the Medicaid waivers and to see what the states are asking for in their waivers.

In addition to work requirements, five states have also asked the U.S. Department of Health & Human Services if they can place a lifetime cap on how long an individual can receive Medicaid coverage. For example, Arizona, would like to place a 5-year lifetime cap on coverage. Kansas, Utah, Maine and Wisconsin are also seeking to impose lifetime caps.

This would be a substantial change to the Medicaid program, since signed into law under President Truman in 1965.  More than 68 million people receive Medicaid coverage, including children, seniors, and people with disabilities.  HHS has not released any guidance on this issue, to date.

Ohio:

Ohio has now joined Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, Mississippi (still in process), New Hampshire, North Carolina, Utah, and Wisconsin, in asking for permission to add a work requirement to their Medicaid program. The work requirement would begin July 1, 2018, if approved in time.

Ohio has also asked the federal government for permission to not comply with the individual mandate. This will likely have no actual impact, as Congress reduced the penalty for not purchasing health insurance to $0, in the latest tax bill. The $0 penalty will begin in 2019, which means that those who don’t have health insurance in 2018 will still be responsible for the penalty!

Rhode Island:

Rhode Island is also making cuts to its Medicaid program, which covers more than 300,000 people. Individuals will be required to pay co-pays when receiving health care services or prescription drugs.  However, there will be an annual cap on co-pays equal to 6% of an individual’s income.

Idaho:

Idaho announced last week that they will allow insurance companies to sell plans in violation of the Patient Protection and Affordable Care Act (ACA). The ACA required health insurance plans to meet certain minimum requirements in order to protect consumers from pre-existing condition exclusions and annual and lifetime limits, while ensuring coverage of essential health benefits. Insurers argue that providing this quality coverage is more expensive and that is why plans sold in the Health Insurance Marketplace can be more expensive.

Idaho’s approach to bring down the cost of insurance is to allow plans to offer less coverage and to exclude people with pre-existing conditions. This directly violate the law. It will be up to HHS to enforce the law or allow Idaho to continue offering these illegal plans. There are many other states waiting to see how HHS will react.

Blue Cross of Idaho has already unveiled five new plans that don’t comply with the ACA, including having annual caps on coverage and pre-existing condition exclusions for up to 12 months.

Advocates have three concerns about this approach:

  1. People who are healthier will leave the Marketplace to buy these cheaper plans, which will drive up the costs of plans in the Marketplace
  2. If these healthier individuals are diagnosed with serious medical conditions, they will find they have inadequate coverage
  3. People with pre-existing conditions won’t be able to purchase these cheaper plans, which means they will be stuck in the marketplace with more expensive plans

This turn of events is very concerning for the cancer community, as it allows insurance companies to do an end run around the ACAs protections for people with pre-existing conditions.

Six Key Things You Need to Know During Open Enrollment

Open enrollment for plans sold in the Marketplaces started yesterday and we have Six Key Things to Know Open Enrollmentbeen hearing that there is still a lot of confusion. As a reminder, open enrollment is the time of year consumers can shop for a new plan or make changes to existing plans. For Marketplace and Medicare plans the plan won’t start until January 1, 2018. Employer plans may have different start dates, so check with your employer. Here are six key things you need to know during open enrollment:

  1. Health insurance can be confusing.
    1. Make sure you understand the key terms used in your health insurance policy. Watch our new video – Triage Cancer Presents: Health Insurance Basics to learn more. This information is useful regardless of where you get your health insurance coverage.
  2. Financial assistance still exists for most people who purchase plans in the marketplace.
    1. For 2018, 8 in 10 people have Marketplace health insurance options for $75 or less, a month. This is mostly due to the premium tax credits available to people based on their income level.
    2. Even though the Administration has said that they will no longer pay the insurance companies back for providing cost-sharing subsidies (aka cost-sharing reductions), the insurance companies still have to provide those discounts to consumers.
  3. Individuals shopping for insurance (regardless of where they get it – Medicare, employers, private companies), should be sure to do the math when comparing options!
    1. Often times we only look at the monthly premium of a plan. However, to accurately determine what a plan with cost you for the year, you have to do the math! Assuming that a consumer will reach their out-of-pocket maximum during the year, the way to do the math is to multiply the monthly premium by 12, then add that amount to the plan’s out-of-pocket maximum. You may be surprised to find that the bronze plan may not be your most affordable option.
    2. Consumers should also look at the network of doctors and hospitals, the other costs (e.g., co-payments, deductibles, etc.), and prescription drug coverage.
    3. For more information on how to pick a plan watch our webinar, Choosing Wisely: How to Pick an Insurance Plan or visit CancerFinances.org.
  4. Individuals who are eligible for Medicare are not eligible to purchase plans in the Marketplace. Visit http://medicare.gov for more information about plan options.
  5. Be wary of short-term health insurance plans.
    1. These plans may look attractive based on their low cost, but they are not considered creditable coverage and when they end, consumers typically aren’t eligible for a special enrollment period to buy a plan in the Marketplaces, which could leave them with a gap in coverage. Additionally, they do not have to include the consumer protections in the ACA and may be able to charge people with cancer more, or exclude covering cancer treatments.
  6. Open enrollment dates may vary depending on where you live.
    1. The federally run Marketplace will be open from November 1 – December 15; however, some states have extended their open enrollment periods.
    2. There are also some extensions available for people who were affected by the recent hurricanes. (see the link above)

Medicare Open Enrollment: October 15-December 7

Do you have Medicare?

The Open Enrollment Period to make changes to your Medicare coverage began on Triage Cancer Medicare Maze WebinarOctober 15 and will end on December 7!

As there will be changes to how much it costs for Medicare Part B and Part D plans, it can be worth your while to shop around and make sure you have coverage that works for you. Any changes you make to your Medicare coverage will take effect January 1.

Here’s a quick refresher on what exactly you get from your Medicare plan:

  • Part A: Covers inpatient care in a hospital or other similar setting
  • Part B: Covers outpatient care like doctor visits, blood tests, imaging tests, and durable medical equipment. Medicare Part A/B is referred to as Original Medicare and can be used with any provider who accepts Medicare. In 2016, the projected cost for Medicare Part B is $159.30 per month. However, there is currently an effort underway to get Congress to reduce the Part B premium cost for 2016. If you cannot afford the Part B premium, you can apply for help here.
  • Part D: Covers prescription drugs and plans vary where you live. Plan costs will be based on the plan you choose. The Medicare Part D Plan deductible will jump to $360 in 2016, from $320 in 2015.
  • Part C: Also called Medicare Advantage plans, they offer Medicare coverage under Parts A, B, and D, through a managed care plans (HMO or PPO). Plans vary based on where you live, but must provide the minimum coverage required by Medicare. Part C plans can be less expensive, but have limited provider choices.

If you already have a Medicare Part D plan, be sure to review its current prescription drug coverage for any major changes to the prescriptions you take. If you are looking to enroll in a new or different Part D plan, compare your options here.

If you or a loved one is managing the costs of care due to cancer, understanding your Medicare options is especially important. Prescriptions used to help manage pain and nausea or to treat cancer can be costly and enrolling in the right prescription drug coverage is important. As you may have seen in the news, drug prices have been on the rise, and this includes drugs that are being used to treat cancer.

Something to be aware of as you look for Medicare coverage is the presence of fraud or scams. Here are some tips to avoid being a victim of fraud:

  1. Remember you do NOT have to change your plan if it still meets your needs.
  2. Beware of free prizes, trips, or other gifts offered in exchange for enrolling in a plan.
  3. Never give out your Medicare or Social Security number to someone unless you are certain of their credentials. (Rule of thumb: don’t give out personal information to someone who calls YOU, vs. someone that YOU call).

As you start looking for the right Medicare and Medigap plans that are right for you, you may have questions. The Centers for Medicare & Medicaid Services and Medicare.gov are reliable resources to help answer any questions you may have.

Don’t be afraid to ask for help. Your family and friends may be able to help you make coverage decisions. Your health care team can also provide you with useful information about the prescription drugs or treatments that you may need now or in the future, so that you can make sure that you pick a plan that covers those things.

There are also community organizations who are available to help you navigate your Medicare choices, called State Health Insurance Assistance Programs. Click here to find the program where you live.

It never hurts to shop around, even just to get piece of mind that the plan that you already have is the best one for you.

Still have questions? Watch our webinar on Making Sense of the Medicare Maze: https://www.youtube.com/watch?v=FIg1nXYV66g

What do donuts have to do with Medicare?

Before the Affordable Care Act, people with Medicare Part D coverage, often fell into a coverage gap, where they would have to pay thousands of dollars out of their own pocket to get the prescriptions drugs they need.

A standard Medicare Part D plan works like this, in 2014:

  • You pay a $310 deductible, meaning that you pay for the first $310 of your prescription drug costs
  • Then Medicare pays 75% of your prescription drugs costs and you pay 25%, until you reach $2,850 in out-of-pocket costs
  • Then you fall into the donut hole, until you reach $4,550 in total out-of-pocket costs
  • After that, Medicare kicks back in and pays 95% of your prescription drug costs and you pay 5%

This coverage gap is known as the “donut hole.” Far from the doughy, sugary-ball of goodness we all remember from days of frequenting the neighborhood donut shop, this deep-fried metaphor is forcing seniors and people with disabilities with Medicare to pay astronomical prices out of pocket for their medications. As a result of the ACA, this gap is closing, making prescription drugs more affordable, and improving care.

How much have people on Medicare saved?

According to the U.S. Department of Health and Human Services, more than 8.2 million people have saved over $11.5 billion on prescription drugs since 2010, for an average of $1,407 per person.

So, the question remains, when and how will the donut hole close?

  • In 2010, anyone with a Medicare Part D plan who reached the donut hole received a $250 rebate.
  • In 2011, people who were stuck in the donut hole began receiving discounts on covered brand-name drugs and generic drugs.
  • In 2014, Medicare will cover 52.5% of brand name drugs and 72% of generic drugs while people are in the donut hole.
  • All and all, Medicare Part D coverage will gradually increase between now and 2020, when (much to the dismay of those who cling to the nostalgic memory of the doughy, sugar-coated ball of goodness) the donut hole will be closed entirely. (see the chart below)

DH Chart

As we approach open enrollment periods, the Affordable Care Act is helping more people get the medication they need, when they need it, without breaking the bank. But don’t worry; the donut shop is still on the corner.

For state-by-state information on discounts in the donut hole, please visit: http://downloads.cms.gov/files/Medicare-Part-D-Donut-Hole-Savings-Summary-2010-June-2014.pdf.

For more information about Medicare prescription drug benefits, please visit: www.medicare.gov/part-d.

Medicare Open Enrollment

medicareandyoucover2-300x225Medicare is a government sponsored health insurance program for most people who are 65 years old and older, or for individuals with a disability, who have been collecting Social Security Disability Insurance (SSDI) for at least 2 years.

Medicare can be confusing to navigate because its coverage is broken into four parts:

  • Part A covers inpatient hospital stays
  • Part B covers outpatient medical services
  • Part C (also known as Medicare Advantage Plans) allows beneficiaries the option of receiving their Medicare benefits through private health insurance plans and combines the coverage of Part A and Part B (meaning that if you have Part C, you do not also need A, B, and D)
  • Part D covers prescription drugs.  Anyone with Part A or B is eligible for Part D

Parts A and B are typically referred to as Original Medicare.  Everyone who is eligible and has paid into the system gets Part A and is automatically enrolled after age 65.  For most people there is no charge for Part A.  To receive Part A for free you generally have had to pay into Medicare for 10 years (40 quarters).  However, if you would like Part B, Part C (Medicare Advantage) and/or Part D you need to take proactive steps to enroll.  There is a fee for each of these Parts.  The standard 2014 premium for Part B is $104.90.  The premiums for Parts C and D will vary depending on the plans you choose.

Each year, during a period of Open Enrollment, you can sign up for a new plan or make changes to your existing plans.  Open enrollment starts October 15, 2013, and ends December 7, 2013.  While you don’t have to make changes this is your opportunity to review your coverage and change plans if you choose.

To find out more about when you can join or change a plan, click here.

To find out more about your Medicare coverage choices, click here or review this Medicare and You 2014 booklet.

Go to www.Medicare.gov to enroll in Medicare, check your current enrollment and compare your coverage options.