Have you reviewed your Medicare Plan this fall? If not, this article is for you. While It is common for a Medicare Advantage organization to add or change benefits each year, sometimes they may need to discontinue a plan altogether. If so, notification must be sent to the plan’s Medicare members by October 2, 2014. Because the plan will no longer be offered, the Medicare members are allowed to join a new Medicare plan anytime between October 15, 2014 and February 28, 2015. However, if you don’t take action before December 31, 2014, you will lose your prescription drug coverage and only have Original Medicare starting January 1, 2015. If you recently received a notice in the mail that your Medicare plan won’t be offered in 2015, be sure to take action now to avoid coverage interruptions or late enrollment penalties.
In October 2013, the Honolulu Advertiser reported that UnitedHealthcare©, citing rising health-care costs as well as changing Medicare rules and government funding, would eliminate its Hawaii Medicare Complete Choice plan in 2014, impacting about 4,000 of their Medicare members that lived mostly in Hawai‘i, Kaua‘I and Maui counties. It is important to note that UnitedHealthcare© did continue to offer other Medicare plans statewide in 2014. Even so, they still have a robust share of the Medicare market.
It is very important to carefully read your mail from your Medicare health plan each fall even if your plan will be offered in 2015. Medicare has an Annual Enrollment Period (AEP) every fall, when all enrollees may evaluate their current plan. It’s an opportunity for Medicare beneficiaries to decide if they want to remain in their existing Medicare plan or select a new one. If you are pleased with your current plan you do not need to do anything. If you review a plan and would like to join, you will be able to enroll in the plan from October 15, through December 7th. Your new plan will become effective the 1st day of the following year or January 1st.
CHOICES ABOUND
The array of choices from all the competing plans can be a bit overwhelming. So once a Medicare beneficiary has decided, the Medicare organization and the Centers for Medicare & Medicaid Services (CMS) provide many tools designed to ease the enrollment process. When the sign-up period begins October 15 and a Medicare bene-ficiary chooses to select a new plan, they have several options:
- they may walk-in to the Medicare plan office to enroll in-person
- schedule an appointment with a licensed Medicare agent
- contact the plan’s customer service department to enroll by phone or visit the plan’s website and complete an online enrollment application
CMS also accepts enrollments, by telephone at 1-800-MEDICARE (1-800-633-4273) or by visiting www.medicare.gov online. Health plans offering Medicare products have toll-free numbers and websites where Medicare-eligible persons may gather additional information before enrolling.
In addition, the State of Hawai‘i has its own agency designed to assist seniors in reviewing the many Medicare plan options available: the State Health Insurance Program (SHIP) office, formerly known as Sage PLUS, offers volunteer counselors to help navigate through the various options. To make an appointment or for more information, call toll free, 1-888-875-9229 or 808-586-7299, or contact them by email at help@hawaiiship.org.
We strongly encourage all Medicare beneficiaries to pay close attention to the steps required to select a new plan. Be sure to act in time to continue coverage that meets your specific health care needs.
COMMON QUESTIONS
Here a few recent questions received regarding Medicare Plans that are ending:
When should a Medicare beneficiary impacted by the terminating plan receive notice?
Companies offering supplemental plans are required by CMS to notify members by October 2, 2014, if the plan will not be renewed for 2015. If you become aware that your Medicare plan is impacted and you have not received a notice by October 2, 2014, you should call your plan to confirm if your plan is ending and alert them that you have not received any notification. It may also be a good time to make sure the company has your correct current address, phone number and emergency contact.
Why is my plan ending?
There can be many reasons and it is best to check with your plan. A company’s decision to cancel one plan is usually a matter of managing the company’s resources to keep their plans financially healthy. Premiums or cost sharing may or may not change. One plan may be discontinued and other plans may be maintained or new plans may be introduced.
Can my existing plan provider auto-enroll me into their new plan options?
Plan providers are prohibited from auto-enrolling clients or switching clients to a new plan without the express permission of CMS If your current plan is no longer offered in 2015, the notice from your provider will have instructions for finding alternative coverage options available in Hawai‘i. You may also contact 1-800-MEDICARE to get help enrolling or visit www.Medicare.gov. Keep in mind, you cannot enroll in a 2015 plan until October 15, 2014 but you can start shopping for information about 2015 plans on October 1, 2014.
Will my premiums and cost sharing with a new plan be higher than my existing plan?
Your out of pocket costs may be more or less depending on the plan you select and the package of benefits and cost sharing it offers. This is precisely the reason you should take time to review all your options and choose a plan that is affordable for you.
Is there a deadline for choosing a new plan so my coverage is not interrupted?
Yes, if your plan is ending December 31, 2014, you may consider your available options and choose a new plan during the seven-and-a-half week Medicare Annual Election Period, which begins October 15, and ends December 7, 2014. If your plan has notified you that it will not be offered, you automatically qualify for a Special Enrollment Period (SEP), which allows you to choose a new plan through February 28, 2015. However, for coverage by your new plan to become effective January I, 2015, you must choose a plan before December 31, 2014.
Delaying your choice of a new plan pushes back the effective date of your coverage. If you exercise your SEP and choose a plan before January 31, 2015, your plan will not become effective until February 1, 2015. If you don’t choose a plan until February 28, 2015, your coverage will become effective March 1, 2015. The SEP available to you at plan termination expires February 28, 2015, unless other SEPs apply.
What happens if I do not select a plan before December 31, 2014?
If you do not enroll in a new plan and no SEP applies, you will be enrolled in Original Medicare (Parts A & B). Any prescription drug coverage under your former plan will end unless you pick up a stand-alone drug plan before December 31, 2014. If you get “Extra Help” to assist with prescription drug co-payments, or have full Medicaid benefits and the State picks up your Medicare prescription drug premium and co-payments, you will be enrolled in Original Medicare and a Medicare Part D stand-alone drug plan.
I am still confused and not convinced that I can handle this process without more help.
Lucky you live Hawai‘i! Your Medicare health plan will likely include plan options available in your area as part of the notification process. Health plans that are discontinuing want to help you with this transition. They have prepared documentation according to CMS guidance and regulations; they will also provide other contacts and websites where you can get additional help.
For more information, call us at 808-543-2073 or email us at getmedicare@aol.com; attend one of our seminars on this topic or invite us for a presentation at your church or senior group.
TAKE ACTION
If your medicare plan is ending this year; be sure to review all your options and enroll in a new plan.
- Carefully read your notice-of-plan-ending
- Note the date you received the letter
- Seek the help of a translator if needed
- Highlight deadlines and keep required copies
- Schedule an appointment with an Agent
- Review plan summary of benefits, formulary, provider directory and supplemental benefits
- If you may be qualified, ask about Medicaid
- Ask about “Extra Help” aka Low Income Subsidy (LIS), it may cover Part D drug premiums and reduce copays
- Learn about guaranteed issue Medigap plans
- Contact your doctor to confirm he accepts plan
- Confirm your medication’s part of the formulary
- Confirm affordability of premiums/cost-sharing
- Complete all steps needed to enroll in new plan
- Note the name of each person you speak with
- Keep list of organization names and contacts
- Accept a “verification of enrollment” call, if requested
- Look for your new Medicare Identification Card
- Provide new Medicare Insurance Card to doctors
- Make your premium payments on time, if any
DOCUMENTS YOU MAY NEED TO COMPARE
Prepare yourself with this handy checklist that can help you provide information to a licensed sales agent, Medicare plan staff or a Medicare representative who can assist you in finding a new plan, or compare the options of an existing plan, that will meet your health care needs.
Find your Red, White & Blue Original Medicare Card that indicates when your Part A and Part B coverage started, call Medicare to request a new one, if needed
Locate any other active medical or prescription drug member identification cards, including Medicaid, if any
Provide a list of the name(s) of your primary care doctor and any specialists you have seen in the last 12 months
Get a list of all current prescription medications with dosage from your doctor’s office
Share a list of your favorite or most commonly used Medicare plan benefits
Prepare a list of any concerns
HOW MEDICARE ADVANTAGE SAVED A LIFETIME OF SAVINGS AND A LIFE
There is nothing that prepares you for a phone call saying that a loved one has been rushed to the hospital after suffering a massive stroke and heart attack. When it is your Mom and you live thousands of miles away, it is even more unsettling.
Jimmie Wilson was totally unprepared when he received that call on January 1, 2013. He rushed to New Jersey to see his Mom, Martha Wilson. His worst expectations loomed in the Intensive Care Unit where amidst a hustle-bustle of nurses and doctors, his mom lay still and unresponsive with tubes everywhere, except around her forehead, which he gently kissed.
In shock and disbelief, he remembered their last conversation. Just two days earlier, he had wished her a “Happy New Year,” just a moment before the stroke of midnight.
Jimmie was fighting back his tears when an ICU nurse tapped his shoulder and said that the finance department wanted him to come by and complete some admissions paperwork. The woman in the finance department smiled warmly when Jimmie came in. She seemed a little too happy to tell him that she had verified that Jimmie’s mom had a new health plan, a Horizon Blue Cross Medicare Advantage plan that became effective at 12:01 am on New Year’s Day. She explained that his mom’s previous Original Medicare plan required a deductible, payable when you get admitted to the hospital. His mom would have been charged over $1,200 for this admission or Jimmy would have been asked to sign an agreement for a payment plan. Jimmie was so focused on his mom’s recovery that it hardly sank in. He thanked the lady and returned to ICU.
Jimmie never returned to work and stayed by his mother’s side daily as she recovered from the stroke that left her paralyzed on her left side, and her speech impaired. At week six in New Jersey, Jimmie was visiting his mom when the doctor stopped by and explained that this patient’s recovery was remarkable. She had been in the hospital for 45 days and now the treatment team was ready to start the evaluation process to release her to skilled nursing. The doctor told Jimmie that his mother’s six weeks of hospitalization might have cost half a million dollars. Out-of-pocket Original Medicare costs would have amounted to tens of thousands of dollars — enough to wipe out a lifetime of savings or all the equity in his mother’s home. Everyone in the hospital was talking about the lucky woman whose Medicare Advantage plan took effect on New Year’s Day. Jimmy watched in amazement, as the doctor and his mom reached up and gave each other a “high five.”
Jimmie’s mom spent a total of 90 days in the hospital and 30 more in skilled nursing. She recovered enough to move in with her son and return to a good quality of life.
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