What to Do if You Missed Medicare’s 2012 Annual Enrollment Period: PlanPrescriber Offers 7 Tips
December 19, 2011
MAYNARD, MA -- The 2012 Medicare Annual Enrollment Period (AEP) officially ended on December 7, 2011, which is three weeks earlier than in years past. At the end of October, one-in-five seniors (19%) on Medicare were unaware that the dates for AEP had changed in 2011, according to an Opinion Research Survey sponsored by PlanPrescriber.com1. And, as a result, many seniors may have missed the opportunity to update their Medicare Advantage and Medicare Part D coverage for the 2012 plan year.
Medicare’s AEP is the time of year designated for Medicare beneficiaries to review and possibly change their Medicare Advantage plan or stand-alone prescription drug plan, before plan benefits change in the new year. People typically only have an opportunity to make these changes during the AEP.
Today, PlanPrescriber (www.planprescriber.com), a wholly-owned subsidiary of eHealth, Inc. (NASDAQ: EHTH), has published seven tips for Medicare beneficiaries who missed the 2012 annual enrollment period and need advice on how best to maximize their drug and health coverage benefits in the coming year.
What to do if you missed the 2012 Medicare Annual Enrollment Period:
- Be Proactive: People who missed the Annual Enrollment Period should not necessarily feel trapped in a plan that will no longer meet their needs. If the plan you had in 2011 changes in 2012, and your monthly premiums, prescription drugs, or other benefits become unaffordable, there are often opportunities to make changes. The key is to be proactive. Reach out to an expert who can help you navigate the process and understand your options.
- Research Your Drug Alternatives: Make sure the drugs you’re taking are the lowest priced drugs for your existing plan. The Medicare Modernization Act (MMA) requires every Medicare Part D and Medicare Advantage prescription drug plan to cover at least two drugs in each category and class. So, if a drug you take isn’t covered by your plan in 2012, or if the price increases significantly, another drug designed to treat the same problem may be available. And, your existing plan may cover that drug at a lower cost. Work with your doctor to find out if such a drug exists and discuss the possibility of switching. Among the ten largest drug plans in the country, no single plan covers more than 79 percent2 of all available prescription drugs in 2012. So, try to optimize the drugs you’re taking to fit your current plan.
- Investigate Special Needs Plans (SNPs): There are Special Needs Plans (SNPs) available for low-income disabled Americans under the age of 65, as well as fifteen types of SNPs designed for people with certain medical conditions. Those who qualify can enroll in a SNP year round, provided one is available in their area. The fifteen chronic conditions currently approved for SNPs include: chronic alcohol and other drug dependence; certain auto-immune disorders; cancer; certain cardiovascular disorders; chronic heart failure; dementia and Alzheimer’s; diabetes mellitus; end-stage liver disease; end-stage renal disease requiring dialysis; certain hematologic disorders; HIV/AIDS; certain chronic lung disorders; certain mental health disorders like bipolar and schizophrenia; certain neurologic disorders; and stroke.
- Investigate Open Enrollment Periods for Medicare Supplement (MediGap) Plans: People who wanted to switch from a MediGap plan to a Medicare Advantage plan, or who wanted to augment their “original Medicare” coverage (Parts A and B) with Medicare Advantage during AEP would typically have limited options once AEP ends. MediGap plans provide another way to augment your original Medicare coverage. But, they’re typically medically underwritten for people who have been on Medicare for more than three months. However, some states and insurance companies have created open enrollment periods for MediGap plans, which allow people to update or change their coverage without medical underwriting. Rules differ by state and by insurance company. So, if you want or need to make a change, investigate your options for MediGap open enrollment by contacting a licensed agent.
- Investigate 5 Star Medicare Advantage plans: The health reform law of 2010 implemented a new 5 Star ratings system for Medicare Advantage plans, beginning in 2012. Plans that received a 5 Star rating for 2012 can be enrolled in outside of the AEP. 5 Star plans are not available everywhere, but a Medicare search engine like PlanPrescriber.com can help you find 5 Star plans available in your area.
- Investigate the Medicare Annual Disenrollment Period (MADP): The ADP allows Medicare beneficiaries to drop out of a Medicare Advantage plan, or “disenroll” from it, should that plan fails to meet their needs. The ADP runs from January 1, 2012 through February 14, 2012. The ADP also allows a beneficiary who dropped their Medicare Advantage plan to enroll in a stand-alone Medicare prescription drug plan so that they don’t have a gap in drug coverage. But, people who abandon a Medicare Advantage plan are giving up additional benefits including the network of providers committed to participate in that plan and an out-of-pocket limit for any medical expenses they incur (provided those costs are approved by Medicare). By comparison, original Medicare does not have an out-of-pocket limit, and you’ll need to be aware of how switching back to original Medicare affects your provider network. Before you disenroll, do your homework to be sure you have the coverage you need in 2012.
- Investigate Medicare Special Enrollment Periods (SEPs): Medicare provides other special enrollment periods, or SEPs, for people who need to change their coverage outside of AEP. Some instances when a person may qualify for an SEP include; when a person moves permanently outside of their plan’s service area; when they lose income making them eligible for a low-income subsidy; if they’ve received inadequate information about what qualifies as creditable prescription drug coverage or lose that coverage through no action of their own; if they were eligible for both Medicare and Medicaid ("dual eligible") but lost their dual eligibility status; if they live in, are moving into, or are moving out of certain types of skilled nursing facilitis; if they receive a retroactive Medicare entitlement determination; or if they qualify for other special enrollment periods that may be authorized by the Federal Government.
1 Data according to a survey conducted by Opinion Research Corporation and sponsored by PlanPrescriber: (http://news.ehealthinsurance.com/pr/ehi/one-in-five-medicare-beneficiaries-219845.aspx)
2 Data according to a report from Avalere Health titled, New Analysis Reveals Number of Medicare Part D Drugs Covered by Prescription Drug Plans Varies Widely. (http://www.avalerehealth.net/wm/show.php?c=&id=893)
PlanPrescriber (www.planprescriber.com), a wholly-owned subsidiary of eHealth, Inc., is a leading provider of comparison tools and educational materials for Medicare Advantage, Medicare Part D Prescription Drug Plans, and Medicare Supplement insurance products. Medicare beneficiaries can take advantage of PlanPrescriber's no cost, no obligation online advisor tools by logging on to www.PlanPrescriber.com. PlanPrescriber is a tool designed to help Medicare recipients find a Medicare plan that covers their specific medical and prescription drug needs at the lowest possible out-of-pocket cost.
eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, one of the nation's leading online source of health insurance for individuals, families and small businesses. Through the company's website,www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of individual, family and small business health plans underwritten by more than 180 of the nation's leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through eHealth's technology solutions (www.eHealthTechnology.com), is also a leading provider of health insurance exchange technology. eHealth provides a suite of hosted e-commerce solutions that enable health plan providers, resellers and government entities to market and distribute products online. eHealth, Inc. also provides online tools to help beneficiaries navigate Medicare health insurance options through PlanPrescriber.com (www.planprescriber.com) and eHealthMedicare (www.eHealthMedicare.com).
For more news and information about health insurance, health reform and Medicare, visit eHealth's consumer blog: Get Smart - Get Covered.
Medicare has neither reviewed nor endorsed this information.