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Open Season for Medicare


October 30, 2011 by Milton Jones

Open Season is just around the corner, and I’m not talking about hunting season. With Medicare coverage, it’s a time when we may change our Part “D” Prescription plan, or Medicare Advantage plan for the coming year.

Actually, the correct language is “Annual Election Period,” or AEP for short. In the past, the AEP began Nov. 15 and ended Dec. 31. This year, the season opens Oct. 15 and closes Dec. 7. Any changes made will then take effect on Jan. 1, 2012. This time lag allows more time for processing your changed enrollment and getting your new cards out to you in the U.S. Mail.

Generally, once enrolled, you’re locked into your plan until AEP time next year, but there are exceptions. Let’s say you enrolled in a new plan before Dec. 7, now it’s Jan. 20 and you already want out. You are allowed to unenroll from your MA plan and go back to Original Medicare coverage between Jan. 1 and Feb. 15. You may also enroll in a stand-alone Part D plan as part of the deal.

One bit of good news for people renewing is that not much has changed for next year on most MA plans. We might have expected higher co-pays and higher premiums; that is, if we have been listening to the news. So, most of us who are on Medicare will not need to worry much about making plan changes for the coming year.

Okay, so maybe you’ve been on a Medicare Advantage with Prescription coverage (MA-PD) plan. You got your big renewal bundle in the mail and find it daunting to dig into all of it.

You should have received: (1) An Annual Notice of Change (ANNOC) …usually a thin booklet, (2) Evidence of Coverage… a thick booklet, (3) A Provider Directory, also available online, and (4) A Plan Formulary (medicine) booklet, also available online.

Should you read it all? Technically, yes … but consider the following shortcut:

• Scan the thin ANNOC booklet for important changes. Look to see if there have been any significant changes in your co-pays or premiums.

• Check the Provider Directory to make sure your physician and your specialist are still in the network. This is especially important if your plan is a HMO.

• Look in the Formulary booklet to see if your medicines are still covered.

If your doctor and hospital are in the provider list, and if most of your medicines are listed, you can feel pretty good about the whole thing. Keep the thick Evidence of Coverage booklet just for reference.

If you are just turning 65, the “open season” (AEP) is not really relevant. People “aging in” have an open window to enroll, which includes their birth month, three months before and three months after. This is called an IEP (Initial Election Period).

If you find all this too confusing, seek out an expert who has taken the certification. If you’re good with the Internet, try this website; This is an excellent resource.

Milton Jones is an Independent Insurance Advisor with experience dating back to 1965. He holds the professional designations of CLU, ChFC, and LUTCF.



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