The holidays quickly came and went, along with December 7th, which is the end of Medicare’s annual enrollment period. Some folks missed their opportunity to add, change or drop their Medicare plan, and they want to know if they have any options now that the annual enrollment period is over.

There are several opportunities to change at this date and we are going to explain each one.

Annual Disenrollment Period:

Each year from January 1st – February 14th is the annual dis-enrollment period. During this time if you are in a Medicare Advantage Plan (AlohaCare, HMSA, Humana, Kaiser Permanent, Ohana Health Plan and UnitedHealthcare), you have a one-time opportunity to change back to Original/Traditional Medicare (only) and enroll in a Medicare Part D plan if your Medicare Advantage plan included drug coverage. You cannot use this opportunity to add or drop prescription drug coverage. If you decide to use this option, please check with your health care providers (favorite physician, therapists) and make sure that they will accept Original/Traditional Medicare and continue to see you as a patient.

New Five-Star Special Enrollment Period:

This is a new benefit in 2012. Medicare has been collecting data on the Medicare Health and Drug Plans and has rated them on a five “star” scale, based on standard performance measures. Five Star being excellent performance and one star being poor performance. Some of the measures include: member satisfaction, managing chronic conditions, staying healthy, customer service and pharmacy benefits. Medicare gets some of this data from the “member satisfaction” surveys that you sometimes receive from your health plan after a visit to the doctor. Also, if you’ve called 1-800-Medicare and registered a “concern or complaint,” they take those calls very seriously.

Not every state and county has access to a five-star plan. In 2012 there are approximately nine health plans in the nation that are “5 stars.” Hawai‘i, be proud, we have one of them. Hopefully in 2013 all of our health and drug plans will be rated with 5 stars.

This special enrollment period is available December 8, 2011– 2012. It is a one-time opportunity to change to a 5 star plan, if it is available in your area. You can do this at anytime beginning December 8, 2011. This special enrollment period again is not an opportunity to add or drop health and drug coverage.

Other Special Enrollment Periods:

If you receive “Extra Help” (also known as low-income subsidy), you have a continuous special enrollment period throughout the year.

Working Individuals. If you didn’t sign up for Medicare Part A and/or Part B when you were first eligible for Medicare (at 65 years of age) and you were covered under an employer group health plan based on current employment (either you or your spouse or family member if you are disabled) and that coverage ends, you have an 8-month window to enroll in Medicare Part B and 63 days to enroll in drug coverage. If you miss either of those windows then you have to wait until the general or annual enrollment periods. COBRA benefits (federal law which allows you to purchase your employer health coverage) is not considered “creditable coverage” for Medicare Part B and you may not be eligible for a special enrollment period and may have to pay higher premiums when you do enroll.

If you would like to know more about special enrollment periods, you can view the Medicare & You handbook (paper form or on-line). For more information about enrolling in Medicare Part B, please visit www.socialsecurity.gov. And for information about Medicare and the health plans available in Hawai‘i, please call Sage PLUS Program, also known as the Hawai‘i SHIP (State Health Insurance Assistance Program). This program is a federal grant from Medicare to assist you in understanding the benefits of the Medicare Program.

 

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