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Medicare Enrollment:
What You Need to Know
September 18, 2014
Brandy Bauer
National Council on Aging
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
1
National Council on Aging (NCOA)
Who We Are:
NCOA is the nation’s leading
nonprofit service and advocacy
organization representing
older adults and the community
organizations that serve them.
Our Mission:
To improve the lives of millions of older adults, especially
those who are vulnerable and disadvantaged.
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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What we’ll cover today
 Quick review: The parts of Medicare
 Medicare enrollment periods: Which one is for you?
 The importance of the Annual Open Enrollment
Period & what you can do
 Ways to assess your Medicare coverage
 Medicare and the Health Insurance Marketplaces
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Quick review: Parts of
Medicare
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Quick review: The parts of Medicare
 Part A: Hospital insurance
• Covers inpatient stays, some costs of skilled nursing facilities,
and hospice care
 Part B: Outpatient coverage
• Covers physicians’ visits, preventive care, medical equipment,
and ambulance services
 Together, Parts A & B are referred to as Original Medicare
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Quick review: The parts of Medicare (cont.)
 Part C: Medicare Advantage
• Medicare offered via private health plans
• Many MA plans also cover prescription drugs and may offer
services above and beyond Original Medicare
 Part D: Prescription drug coverage
• Private plans that cover prescription medications (different
formularies mean different coverage rules/rates by plan)
 Medigap (Medicare Supplemental Insurance)
 Purchased through private companies
 Pays for cost-sharing for Parts A & B and other services not
covered by Original Medicare
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Enrollment periods
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Enrollment periods: Resources
 Understanding Medicare Enrollment Periods (official
Medicare publication):
http://www.medicare.gov/Pubs/pdf/11219.pdf
 Download NCOA’s calendar of enrollment periods:
http://www.ncoa.org/enhance-economic-security/centerfor-benefits/mmm-counselors-corner/enrollment-periodscalendar.html
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Knowing when to enroll is important!
 If you don’t enroll on time, you could face steep penalties
 Part B penalty:
• Part B premium increases 10% for every 12-month period you
could have had Part B but did not enroll
 Part D penalty:
• 1% of the average Part D premium ($32.42 in 2014, or 32 cents),
times the number of months late enrolling, rounded to the nearest
10 cents
• Example: You missed enrolling in Part D by 12 months in 2014;
your premiums would cost an added $3.80 every month
 These penalties last as long as you have Medicare!
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Who gets automatically enrolled into Medicare?
 Some people are automatically enrolled into Medicare
(Parts A & B):
• People receiving Social Security Disability Insurance (SSDI)
benefits will get Medicare after 24 months of receiving
SSDI
 People with ALS (Lou Gehrig’s disease) get Medicare as soon as
they start to receive SSDI
 People with End Stage Renal Disease don’t get Medicare
automatically, but can apply after 3 months of dialysis
• People turning 65 who already receive Social Security or
Railroad Retirement Board benefits will be automatically
enrolled around their birthday
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Enrollment periods: Initial Enrollment Period
 Everyone gets an Initial Enrollment Period (IEP) during 7month window around their 65th birthday
• Can apply up to 3 months before and 3 months following birthday month
• Coverage start date depends on enrollment, but no sooner than birthday
month
 During IEP, you can enroll in Parts A, B, & D
• Can choose Medicare Advantage plan after you’ve enrolled in A & B
 If you don’t enroll during your IEP and don’t qualify for
Special Enrollment Periods, you may pay a penalty for
joining Medicare later
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Enrollment periods: Medigap Open Enrollment
Period
 People turning 65 and enrolled in Parts A & B have a 6month window to enroll in a Medigap plan
• Enrollment period starts during the 1st month you are age 65 and
enrolled in Part B
• For those who still have coverage through active employment at
65, you get a 63-day period to enroll when that coverage ends
• Not subject to medical underwriting (companies must sell the
policy regardless of medical history)
 People under 65 with Medicare may be able to buy a
Medigap policy, depending on your state
• May be subject to medical underwriting and pay more based on
your condition
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Enrollment periods: Special Enrollment Periods
 Some people get special windows to enroll/change
coverage without penalty:
•
•
•
•
Lose active employee/spousal coverage (not COBRA)
Move out of a plan’s active coverage area (for Parts C & D)
Enter or leave an institution
Qualify for Part D Low Income Subsidy (for Part D only)
 If you/spouse is actively working and covered under
employer coverage, you may have an option to delay initial
enrollment into Medicare
• Have an 8-month window when current coverage ends to enroll in Part B
• Have 2-month window to join Parts C/D after current coverage ends
• Have a 63-day window to pick up Medigap plan
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Enrollment periods: General Enrollment Period
 For people who did not sign up for Parts A & B when first
eligible, and who do not qualify for Special Enrollment
Periods
 Runs Jan. 1 – March 31 each year
 Coverage starts July 1
 May be subject to penalty for late enrollment
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Enrollment periods: MA Disenrollment Period
 For people who have Medicare Advantage (MA) and want
to leave their plan and return to Original Medicare
 Runs Jan. 1 – Feb. 14 each year
 Can also pick up a Part D plan if you don’t have one
already
 Cannot switch between MA plans, Part D plans, or move
from Original Medicare to MA
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Enrollment periods: Open Enrollment Period
 Runs Oct. 15 – Dec. 7 each year
 Anyone with Parts A & B (including those who already are
in Medicare Advantage and/or Part D plans) can:
•
•
•
•
Change from Original Medicare* to Medicare Advantage
Leave Medicare Advantage and go back to Original Medicare
Join, drop, or change Part D plan
Switch Medicare Advantage plans
 New coverage starts on Jan. 1
*People with Original Medicare and Medigap plans should weigh the decision
to take MA carefully; they may not be able to get Medigap again
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Getting ready for open
enrollment
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Open enrollment matters!
 Plans change, and so do you!
 Annual guaranteed opportunity to assess and make
changes in coverage
 Potentially save on out-of-pocket costs
 Yet the majority don’t take advantage of it:
• 2010 survey from Kaiser Family Foundation found that only 13%
of beneficiaries switched plans during open enrollment
• Of those who didn’t change plans, most saw an increase in
premiums the following year
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Consider the 4 Cs
 Cost
• What is the annual cost of the plan (premiums, deductible,
coinsurance, copayments)?
• What tiers do your medications fall into, and how does this affect
what you pay for them?
• Did you enter the prescription drug coverage gap (“donut hole”)
last year?
 Coverage
• Review coverage of strength, dosage, and route of administration
and any formulary limitations in your plan
• How does the coverage/plan rank under Medicare’s star quality
rating system?
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Consider the 4 Cs (cont.)
 Convenience
• Can you get your prescriptions at your preferred pharmacy or by
mail at the preferred price?
• Does the plan restrict access to medications (prior authorization,
step therapy, quantity limits)?
• Can you get medication while travelling/living part of the year
elsewhere?
 Customer Service
• How responsive is the plan to your problems/questions?
• Again, what is the overall quality rating for the plan?
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Also consider other potential savings
 Good opportunity to see if you qualify for the Part D
Low Income Subsidy (Extra Help)
• Helps pay Part D premiums and reduces copayments for those
who qualify
 Also check to see if you may get help from other
programs
• State Pharmaceutical Assistance Program
• Drug manufacturer rebate programs
 Use our online screening tool at:
www.benefitscheckup.org
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Ways to assess your Medicare
coverage
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Medicare.gov
 Official Medicare website
 Plan Finder: https://www.medicare.gov/find-a-plan allows
you to compare plans and coverage in your area
 Find out if your test/service is covered at:
https://www.medicare.gov/coverage/your-medicarecoverage.html
 Can create a personal account at MyMedicare.gov to track
claims and coverage
 Call 1-800-MEDICARE (1-800-633-4227) with questions
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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State Health Insurance Assistance Programs (SHIPs)
 Federally funded to provide objective assistance to people
with Medicare and their families
 Called different things in different states (e.g., SHINE,
HICAP, CLAIM)
 Search at www.medicare.gov/contacts or www.shiptalk.org
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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My Medicare Matters
 www.mymedicarematters.org
 Educational service from NCOA that walks you through
Medicare enrollment, coverage, costs, and more
 Prescription drug savings calculator
 Take the Medicare QuickCheck™
• Get personalized recommendations for your situation
• Identifies whether you may be able to save on costs through
subsidies/benefit programs
• Connections to get assistance in enrollment and choosing a
plan
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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My Medicare Matters (www.mymedicarematters.org)
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Medicare & the Marketplaces
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The Health Insurance Marketplaces
 Available at www.healthcare.gov
 Established under Affordable Care Act
 Individuals and small businesses can buy affordable
coverage for themselves/their employees
• People with incomes between 100% and 400% of poverty
get subsidies/tax credits to help pay for coverage
 Also can enroll in Medicaid and Children’s Health
Insurance Program (CHIP)
 Marketplace open enrollment for 2015 runs Nov. 15,
2014 – Feb. 15, 2015
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Do the Marketplaces affect Medicare?
 The Marketplaces do not affect Medicare coverage
 Medigap policies, Medicare Advantage plans, and
stand-alone Part D drug coverage will not be sold
through the Marketplaces
 People with Medicare should not use the Marketplaces
to change their coverage
 It is illegal for a Marketplace representative to sell a
plan to someone they know has Medicare
 Once a person becomes eligible for Medicare, they will
lose those Marketplace subsidies/tax credits
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Learn more
 Center for Benefits Access at NCOA:
www.centerforbenefits.org
• Fact sheets on Medicare, enrollment periods, and Affordable Care
Act
• Free monthly webinars on topics related to Medicare and benefits
 Medicare Rights Center
• 1-800-333-4114
• Medicare Interactive: www.medicareinteractive.org
• More info on Marketplaces and people transitioning to Medicare
Improving the lives of 10 million older adults by 2020
© 2014 National Council on Aging
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Get involved with NCOA
 Visit ncoa.org and sign up
to receive news, resources, and
opportunities to learn and act.
 Donate to support NCOA’s work:
ncoa.org/Donate.
 Share NCOA’s free, trusted tools with older adults.
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


BenefitsCheckUp.org
EconomicCheckUp.org
MyMedicareMatters.org
RestartLiving.org
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© 2014 National Council on Aging
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Questions?
Brandy Bauer: [email protected]
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