Open Enrollment Q&A. A primer to Medicare s Open Enrollment Period created by Medicare expert, Diane J. Omdahl, RN, MS

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1 2013 Open Enrollment Q&A A primer to Medicare s Open Enrollment Period created by Medicare expert, Diane J. Omdahl, RN, MS

2 2013 Open Enrollment Q&A A primer for Medicare s Open Enrollment Period in 2013 create by Medicare expert, Diane J. Omdahl, RN, MS Medicare s Open Enrollment period is a very important part of managing your coverage. This list of common questions with answers by Diane Omdahl provides you with the basic information that any Medicare beneficiary should know about Open Enrollment. In the preparation of this information, 65 Incorporated has made every effort to include the most correct, current, and clearly expressed information possible. Actual decisions about Medicare coverage depend on the individual s exact circumstances, supporting facts, regional variations, and any future changes. 65 Incorporated disclaims any responsibility for any misunderstanding on the part of readers. This booklet is protected by copyright law that prohibits reproduction without the permission of the copyright owner. 2013, 65 Incorporated. All rights reserved. Advice given is general. Readers should see professional guidance for specific health, coverage, or financial questions. All rights reserved under International and Pan American Copyright Conventions. Produced and published in the United States by: 65 Incorporated 1009 W. Glen Oaks Lane, Suite 105 Mequon, WI Revision 1.1, August 2013

3 2013 Open Enrollment Q&A A primer to Medicare s Open Enrollment Period created by Medicare expert, Diane J. Omdahl, RN, MS

4 About 65 Incorporated 65 Incorporated is an innovative online resource to guide you and your family through the Medicare planning process. Founded in Milwaukee in 2012 by registered nurse and nationallyknown Medicare expert Diane J. Omdahl and her daughter Melinda Caughill, 65 Incorporated is an independent and unbiased source of Medicare guidance. We don t sell insurance and we don t work for the government. Our only interest is in helping you get the most out of Medicare. 65 Incorporated is different from other Medicare help because we re dedicated to the 4 Cs of Medicare. Clear We present complication Medicare information in understandable terms. Correct Our experts information is always up-to-date and accurate. Complete We can guide you all the way through the Medicare process from start to finish. Credible Our sole purpose is to provide unbiased advice based on accurate information. 65 Incorporated does not sell insurance and we make no money from the insurance companies or Medicare. We are not (and don t want to be) endorsed by the government. 4 v1.1 Copyright 2012, 65 Incorporated All Rights Reserved

5 About the Author & Presenter Diane J. Omdahl, RN, MS Diane J. Omdahl is co-founder of 65 Incorporated. A pioneer in home health agency management and training, Diane has kept her finger on the pulse of the healthcare industry s evolution for more than 30 years. She is best known for authoring one of the most resourceful guides to the Medicare process for homecare agencies, the Beacon Guide to Medicare Service Delivery. With her extensive experience in healthcare industry leadership roles, Diane is able to provide a wealth of clear and unbiased information to the aging population through 65 Incorporated. Diane is a registered nurse who previously launched and built Beacon Health Corporation into the leading provider of education, training and tools for home health agencies and their employees. Her extensive experience includes presenting more than 300 audio conferences and 100 seminars, along with producing instructional videos and educational resources for home health aides, registered nurses, and therapists. She has been published in many healthcare publications including: The American Journal of Nursing, Caring Magazine and House Calls: The Newsletter. In addition, she served on the advisory board for Columbia College of Nursing and is a charter member of the MSOE School of Nursing Honor Society. Diane received Bachelor of Science and Master of Science degrees from Cardinal Stritch University and a nursing diploma from the Columbia Hospital School of Nursing Open Enrollment Q&A 5

6 Open Enrollment Q&A What is the Open Enrollment Period? This is one time every year that Medicare beneficiaries have an opportunity to modify their coverage. It is also called the Annual Coordinated Election Period or the Annual Election Period. When is the Open Enrollment Period? The Medicare Open Enrollment Period is October 15-December 7. What can I do during the Open Enrollment Period? There are several things you can do. The actions depend on the type of coverage you have now. If you are on Original Medicare, you can drop that coverage and enroll in a Medicare Advantage plan. If you have Part D prescription drug coverage with Original Medicare, you can change drug plans or drop the prescription drug coverage entirely. (Think very carefully about dropping the coverage because there can be repercussions.) If you don t have drug coverage with Original Medicare, you can join a Medicare Part D prescription drug plan. If you have a Medicare Advantage plan with prescription drug coverage (known as an MA-PD plan), you can switch from that plan to another Medicare Advantage plan. You can also switch to a Medicare Advantage plan without drug coverage. (Remember, there can be repercussions.) If you have a Medicare Advantage plan without drug coverage, you can switch from that plan to another Medicare Advantage plan without drug coverage or add drug coverage through an MA-PD plan. 6 v1.1 Copyright 2012, 65 Incorporated All Rights Reserved

7 Open Enrollment Q&A Anyone with a Medicare Advantage plan (with or without drug coverage) can decide to drop that plan and change back to Original Medicare. However, people who make this switch may not be able to purchase a Medigap policy. When do these changes take effect? Any changes made during the Open Enrollment Period, such as switching to a different MA-PD plan, take effect on January 1. How should I prepare for Open Enrollment? In October, Medicare Advantage and drug plans must send to members any changes in its plans. The Annual Notice of Changes is a summary of changes to your benefits and costs that will take effect January 1, If you have prescription drug coverage, this can include changes in the formulary or list of medications the plan covers. The plan will also send the Evidence of Coverage, a detailed description of benefits and costs for Compare the information in those documents with the ones in effect for 2014, looking for any changes. What things about my coverage can change? Here are some of the items about healthcare coverage that may change: the monthly premium the annual out-of-pocket spending limit the annual deductible your out-of-pocket costs (copayments, coinsurance) coverage rules for medications (quantity limits, step therapy, and prior authorization) A drug plan may change: 2013 Open Enrollment Q&A 7

8 Open Enrollment Q&A its formulary the tier of a medication the annual deductible copayments or coinsurance coverage of medications in the Coverage Gap, also known as the donut hole What if I don t want to change anything? If you are satisfied with your coverage and costs, don t do anything. Your plan will automatically reenroll you for next year. However, even if you are satisfied, still take time to evaluate changes in your existing plan. If benefits or costs have changes, you can do some window-shopping. Use the Medicare Plan Finder to compare a few plans. If I missed enrolling in Medicare during the Initial Enrollment Period, can I do that during the Open Enrollment Period? No, you cannot. If you did not enroll during the Initial Enrollment Period, you must wait until the General Enrollment Period, which is January 1-March 31. Medicare coverage will take effect on July 1. Can I wait until the next enrollment period, January 1-February 14, to switch plans? There is an enrollment period in January; however, this is the Medicare Advantage Disenrollment Period. During this time, a beneficiary who has a Medicare Advantage plan can drop that coverage, called disenrollment, and switch back to Original Medicare and obtain stand-alone prescription drug coverage. Remember, it may not be possible to purchase a Medigap policy. 8 v1.1 Copyright 2012, 65 Incorporated All Rights Reserved

9 Open Enrollment Q&A Medicare's Open Enrollment Period Important Dates SEPTEMBER 15 - OCTOBER Watch for Medicare & You 2014 and annual notice of changes from your current plan. September 15 PREPARE FOR OPEN ENROLLMENT Brace yourself for a marketing deluge from Medicare Advantage, prescription drug, and Medigap plans (also known as Medicare supplement plans) OCTOBER 1-14 October 1 START YOUR RESEARCH Begin comparing 2014 plan information, benefits, costs, drug information, and plan quality ratings. OCTOBER 15 - DECEMBER To compare plans, use the Medicare Plan Finder at medicare.gov. OPEN ENROLLMENT PERIOD BEGINS Decide whether you will make any changes and carry through on them. To make changes, you can: Call Medicare Go online to medicare.gov Fill out and mail a printed enrollment form. JANUARY 1 Your new plan takes effect. November December 7 January 1 If you decide not to make changes, your current plan will automatically re-enroll you. Don t assume your current plan will remain the same next year. Plans often make cost and/or coverage changes year-to-year. Doublecheck your plan for any changes that may effect you next year. YOUR NEW PLAN TAKES EFFECT 65Incorporated.com Clear, Correct, Complete & Credible Medicare Answers 2012, 65 Incorporated v Open Enrollment Q&A 9

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