This article will explain the upcoming alphabet soup of election periods, and what you can do during each. Implicit in this discussion is that you are currently in some sort of Medicare additional coverage — either a Medigap plan or a Medicare Advantage plan.
From October 15th – December 7th, the Annual Election Period or AEP, you may change from any Medicare Advantage plan that you already have to any other Medicare Advantage available in your service area (ie. county). The new plan will take effect on January 1, 2020.
You can also drop a Medigap plan you may be on, and join a Medicare Advantage plan.
If you have a Medigap plan, and are happy with that plan, but you would like to review your drug coverage, you can change from your current Part D plan to any other outpatient drug plan available in 2020. In the first two chapters we explained that there are a lot of new Medicare Advantage plans with new benefits and new Part D plans that can be looked during an annual review.
Just call to make an appointment and we’ll take care of the review for you. When we talk, to make sure we find options that are best suited for you, is a description of any new medical an/or medication requirements:: doctors sometimes change networks, perhaps you want to find a new provider or hospital to deal with, you may have new prescriptions that we need to see which plan offers the lowest cost, and so forth.
Once again, from January 1 – March 31, we will have what we are now calling the Medicare Advantage Open Enrollment Period (MA-OEP). During this time, you can can the Medicare Advantage plan you are one to a new plan. You can also disenroll from your Medicare Advantage plan and go back to Original Medicare (which means you can apply for a Medigap plan), and also add a stand alone Part D plan. Why might you want to do this? Perhaps the Medicare Advantage plan you either had or joined during the AEP hasn’t turned out the way you wished; sometimes a doctor that was in network has left that network all-of-a-sudden. In short, it is a chance to make a change to your 2020 choice.
A note of grammatical caution — you may hear the term “Open Enrollment Period” multiple times, which are sometimes used in conflicting conflicts. If you have any questions about my descriptions above, just give me a call to discuss.
As a following note, the AEP and MA-OEP do not involved Medigap plans. Medigap plans can certainly be examined during AEP, but since Medigap plans can be replaced at any time of the year, there is no requirement to do it during AEP.
As mentioned nearby in this edition, the AEP offers you the chance to make changes to your medical and drug coverage.
The best process, is to come to an upcoming Member Meeting to get a run down on the 2020 benefits in your existing Medicare Advantage plan. At these meeting we will be running through the detailed benefits of your plan into the 2020 season.
If you would rather examine all possibilities for next year, we will be making appointments during the Member meetings, or you can call and make an appointment. We take in-office visits, over-the-phone, or over-the-internet appointments.
During the appointment, we will update your medications list and search all 2020 plans for the best deal. We will also check out any new medical requirements or issues to see if you will want to consider a change in your medical coverage.
That’s OK! You can enroll in your Initial Election Period, even if it does happen this fall. The AEP has no effect on you this year. Your first AEP will occur next year.
Vaccines are a funny thing with Medicare. Some are paid for under your basic Medicare coverage, and some are paid for through your Part D plan.
Flu shots and pneumonia vaccines are actually paid for through your Original Medicare coverage, under Part B. However, you can get these vaccines at either the doctor’s office or at a pharmacy that participates in Part B. Be sure to ask if the pharmacy bills Part B.
The above is particularly important if your additional coverage is through a Medigap plan.
If you have a Medicare Advantage plan, the provider(s) must be in that Medicare Advantage plans’ network.
The shingles vaccine is a two-part regimen. It is only covered by your Part D plan, and is administered through a pharmacy, unless you have one of the rare doctors’ offices that is contracted directly with a Part D plan. Working a pharmacy, you will need to “reserve & schedule” your vaccine dosage due to supply shortages. You may also have to pay a large portion of the cost of the vaccine if your Part D plan has a deductible. Many Part D plans these days abate the deductible for T1 and/or T2 generics, but apply the deductible to the higher tiers. The shingles vaccine, a brand name medication, is always in a higher tier.
Most people think of their annual checkup when they hear this term. Under Medicare there’s a lot more to it.
Wellness screening presents a series of age appropriate evaluations that may or may not require the medical provide to do anything more than ask some questions. Others, such as a colonoscopy, are invasive. Medicare covers certain wellness screenings. Here’s the Medicare booklet that lays out everything covered by Medicare in an annual wellness screening. Keep in mind that some procedures are covered as gender and age appropriate, while some are covered in accordance with the US Preventive Services Task Force recommendations.
A full annual physical exam is what most people imagine when they think of preventive care, but actually includes many categories of examination as described above, but is also more extensive. Medicare does not cover services if billed as a physical exam with the exception of the Welcome to Medicare care visit. Instead the provider has to bill Medicare under other medically necessary cost codes in order to be paid.
Ask your provider about how they handle this distinction as it can affect your out-of-pocket expense. Note that most Medicare Advantage plans do in fact cover an actual physical exam, as discussed here.
Brokers who offer Medicare Advantage and Part D plans to Medicare beneficiaries have to be certified by passing a test each year with at least a 90% score. In addition, every carrier that offers these plans requires brokers to also certify on their plans and Medicare regulations. In most cases, thee tests must be passed with an 85% or higher grade. A few insurance companies that offer Medigap plans require a certification, but most do not. A great deal of what Medigap plans offer, however, is covered by the National Medicare certification.
Certification training not includes material on Medicare and Medicare regulations, but also on Fraud, Waste, and Abuse programs, as well as on privacy and identity protection regulations and programs