May 26, 2024
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Medicare Open Enrollment: Don’t Miss Out

Every year Medicare beneficiaries have a choice. Between October 15 and December 7, a period known as “open enrollment,” Medicare beneficiaries can switch their current Medicare coverage. The Senior Medicare Patrol of New Jersey (SMP) program, which is located at Jewish Family Services of Middlesex County in Milltown, New Jersey, wants you to know what your options are so you can make the right decisions and avoid the wrong choices that can cost you money. The SMP is a federally funded program of the Administration for Community Living. Every state has a Senior Medicare Patrol program.

Why make a change? If, as a Medicare beneficiary, you are enrolled in Original Medicare (Medicare Part A and/or B), and have a prescription drug plan, Medicare Part D, or if you are in a Medicare Advantage Plan, Medicare Part C, your plan can change how much it costs and what it covers. Even if they remain the same, your health or finances may have changed. SMP encourages all beneficiaries to re-visit their coverage and decide whether or not to change during open enrollment.

If beneficiaries want to make changes, their choices are as follows:

1. If you are enrolled in Original Medicare, you can switch to a Medicare Advantage (MA) plan with or without drug coverage. MA plans are private companies approved by Medicare and give you the services of Original Medicare. If you join a MA plan, you do not need (and are not permitted) to have a Medicare supplement insurance plan (also known as a Medigap policy) and if your MA plan has drug coverage, you will not need a Part D plan. Also, MA plans may be offering additional services that were not previously available. Many MA plans were already offering some dental, vision and hearing services that are not available in Original Medicare. Now, plans may offer services such as adult day care, home and bathroom safety devices, transportation, home-delivered meals, home-based palliative care, support for caregivers, “memory fitness” benefits and certain over-the-counter items.

2. If you are already in a Medicare Advantage Plan, you can switch to another Medicare Advantage plan or drop your Medicare Advantage plan. If you decide to drop a plan and not switch to another plan, you will be enrolled in Original Medicare. You should then consider enrolling in a Medicare supplement insurance plan to cover the costs that Original Medicare does not pay for and enroll in a Part D plan for drug coverage.

3. If you are in Original Medicare with a Part D plan, you can stay in Original Medicare and switch your Part D plan.

4. If you are in Original Medicare and do not have a Part D plan, you can enroll in a Part D plan. If you join a Part D plan because you did not do so when you were first eligible for Part D and you did not have other coverage that was, on average, at least as good as standard Medicare drug coverage (known as creditable coverage), your premium cost will be penalized 1% for every month that you did not enroll. You will have to pay this penalty for as long as you have a drug plan. The penalty is based on the national average of monthly premiums multiplied by the number of months you are without coverage and this amount can increase every year. If you qualify for extra help (low income subsidy), you won’t be charged a penalty.

Why change Part D plans? Beneficiaries may want to change Part D prescription drug plans (PDPs) for a number of reasons: (i) The PDP has notified the beneficiary that it plans to drop one or more of their drugs from their formulary (list of available medications), (ii) the PDP has notified the beneficiary that it will no longer participate in the Medicare Part D program, (iii) the PDP will increase its premium or co-pays higher than the beneficiary wants to pay and a less expensive plan may be available and (iv) a beneficiary is not happy with the PDP’s quality of service or the plan has received low rankings for a number of years. For 2020, beneficiaries in New Jersey can expect to choose from a number of PDPs. The list of plans can be found at the back of the Medicare and You 2020 booklet, which beneficiaries should now be receiving in the mail. In addition, remember that using generic drugs whenever possible will save you money. Sometimes you can save even more money if you buy your medications by mail if your plan has a mail-order option. Check with your plan.

Note: The Medicare Part D coverage gap, also known as the donut hole, will disappear effective January 1, 2020. This means that a beneficiary will pay the co-pays or 25% coinsurance for their prescription drugs.

Compare plans each year. Beneficiaries should remember that PDPs will change every year and it is recommended that beneficiaries compare plans to insure that they are in the plan that best suits their needs. Medicare is introducing a new, updated Medicare Plan Finder to assist beneficiaries in comparing Part D drug plans. The Plan Finder can also be used to compare MA plans.

When comparing plans, keep in mind to look at the “estimated annual drug costs,” i.e., what it will cost you out of pocket for the entire year, from January 1 through December 31 of that year. Plans can be compared at the Medicare web site: www.medicare.gov. If you do not have access to a computer, call Medicare at 1-800-Medicare for assistance in researching and enrolling in a new plan. Medicare can enroll a beneficiary over the telephone. When you call, make sure you have a list of all your medications, including dosages and the number of times a day you take the medication. Another resource for Medicare beneficiaries is the State Health Insurance Assistance Program (known as SHIP), telephone 1-800-792-8820. SHIP is federally funded and can provide beneficiaries with unbiased advice. Call SHIP to make an appointment with a counselor. You do not need to use a broker or agent, who may not be looking out for your best interests. Brokers and agents are usually being paid to enroll you in certain plans. Beneficiaries can also call the Senior Medicare Patrol of New Jersey at 732-777-1940.


Charles Clarkson, Esq., works at Jewish Family Services of Middlesex County and is the project director, Senior Medicare Patrol of New Jersey.

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