Don’t Fall Behind!

It is that magical time of the year. The pumpkins are at the open markets, the air is a bit cooler and it’s time for your Medicare Check-Up. You don’t need to see your doctor for this checkup, just sit down and reflect back on the past year.

Questions to ask yourself:

  • Have my medical needs changed?
  • Am I taking more medicine than I did in 2012?
  • Have I experienced an ambulance ride, emergency room or hospital stay?
  • Am I in the best plan for my circumstances?
  • Do I have the coverage that I need and is it affordable?
  • Is there anything new in the market?
  • Do I need to change plans?

Open Enrollment begins October 15, 2012 and ends December 7, 2012.

This is an opportunity to change, drop or add a plan that will begin on January 1, 2013. Plans may begin marketing their 2013 products on October 1, 2012, and at that time we will know whether or not plans will leave Hawaii or if new plans will be available.

Some changes to expect with Medicare Part D – the drug plan, include:

  • Those who reach the coverage gap will continue to see discounts on certain drugs. While in the gap, patients will receive a 21% discount on all generics and a 52.5% discount on all brand-name drugs covered by the plan. These discounts are automatically applied at the pharmacy.
  • Starting in 2013, Part D plans are allowed to cover benzodiazepines and certain barbiturates, such as those used in the treatment of epilepsy, cancer or a chronic mental disorder. With barbiturates, plans may require “prior authorization” (meaning the plan will not provide coverage until the doctor submits a request to the plan and receives approval) to verify treatment. Previously, “benzos” and “barbs” were previously excluded drugs from Part D coverage lists.

Enrollment changes for Medicare Health and Drug plans are as follows:

  • New special enrollment period for People in Certain Low-Performing Plans: In an effort to promote better plan quality and better choice, Medicare will be sending notices to those who are in a Part D drug plan or Medicare Advantage health plan that fail to get at least a 3-star quality rating for three straight years. The notice lets them know about a Special Enrollment Period to enroll in a 4- or 5-star plan. For more information, visit or call 1-800-633-4227 after October 15, 2012.
  • Low-Performing Plans and the Medicare Plan Finder: In order to promote high-performing plans, Medicare is disabling the online enrollment feature in the Medicare Plan Finder (MPF) tool for low-performing plans (3 or fewer stars for three consecutive years). These plans will have a low-performing icon, along with a message warning consumers of the plan’s poorly rated performance. Individuals still interested in enrolling will get another message letting them know they will need to call the plan directly to enroll.

Now, the great news … you are not alone and we will not let you fall behind. The Sage PLUS Program/Hawaii SHIP is the Medicare Counseling Program for the State of Hawaii. Our certified volunteers can walk you through the Medicare Check-Up and assist you in understanding your options. Contact SHIP at 1-888-875-9229 (toll free). Leave your name, phone number and your zip code so that we can connect you with a certified volunteer in your area. Or, e-mail or visit

Sage PLUS - Generations Magazine - June-July 2013


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