Annual Enrollment Period (AEP)

Salvador Dali is credited with once saying, “What is important is to spread confusion, not eliminate it.”  If you’ve been on Medicare for more than 10 minutes, you probably think that the Centers for Medicare/Medicaid Services (CMS) came up with this line.  And it’s easy to see why.  The bureaucracy and complexity of Medicare can be overwhelming.  And certain times of the year seem to highlight this feature – like the Annual Enrollment Period (AEP).

The AEP is a timeframe each fall in which you can make changes to your Medicare coverage.  We have found that there is a lot of confusion around what you can and cannot do during this period.  Hopefully the information below will help clear some things up.

What the AEP is:

• AEP begins on October 15th and ends on December 7th.
• During AEP you may enroll into or disenroll from a Prescription Drug Plan.
• During AEP you may enroll into or disenroll from a Medicare Advantage Plan.
• If you already have a Prescription Drug Plan or Medicare Advantage Plan, you may change your plan during AEP if you wish.
• Any changes you make during the AEP will be effective January 1st of the upcoming year.

What the AEP is NOT:

• AEP does not affect a Medicare Supplement (Plan F, G, etc).  If you have a Medicare Supplement, you can change your coverage anytime during the year, and you are not required to do anything during the AEP.
• AEP does not require you to make any changes to your coverage.  If you are happy with your plan, it will continue into the next year with no action required on your part.
• AEP is not the end of the world.  :-)  

Although the AEP may seem very confusing and daunting, we assure you that we can help guide you through it all.  If you have questions about your coverage or your options during this AEP, please feel free to call or email us anytime.

ANOC

ANOC  (ә / näk)
   noun

1. An acronym that stands for:  Annual Notice Of Change. 
2. The document that is sent out each year by Prescription Drug and Medicare Advantage Plans that updates members as to changes in their coverage.
3. A very important document that should be reviewed carefully.

Well, it’s getting to be that time of year again.  Although it seems like it was just summer yesterday, we are already less than two weeks from October.  Of course you know that we are getting close to fall because you’ve started getting more and more email.  The Medicare Annual Enrollment Period is just around the corner, which means open season for Medicare marketers.  This means that you may find your paper recycle bin bulging at the seams as you try to keep ahead of all the solicitations and various junk mail.  There is however, one very important piece of mail for which you will want to be on the lookout.  That’s right, it’s your Annual Notice Of Change (ANOC).

If you have a Prescription Drug Plan or are enrolled in a Medicare Advantage Plan, you will get one of these every fall.  If you do not have a Prescription Drug Plan and you are not enrolled in a Medicare Advantage Plan, well then my friend, you can stop reading right here and take the rest of the day off!  But for those of you who do, keep reading. 

This document is very important because it will detail the changes in your plan for the upcoming year.  This will help you make the decision about whether or not you will keep your current plan, or shop for another.  The document itself is generally divided into two sections.  The first section is a brief summary of the highlights of the plan changes, and the second is a more detailed account of the previous year’s benefits next to the upcoming year’s benefits.  Typically this is done in a two column chart that makes comparison very easy.  As you look through these changes, we would recommend asking the following questions as a guide for keying in on some of the major, and sometimes harder to see, issues.

For Prescription Drug Plans ask:

    Did the monthly premium change?
    Did the drug copayments change?
    Are there any significant changes to the list of participating pharmacies?
    Are there any changes to the list of covered drugs that effect you (such as a change in drug tier)? 
    Are there any additional restrictions on the drugs that you're taking (such as step therapy, or quantity restrictions)?

For Medicare Advantage plans, ask the following questions in addition to those above:

    Did the annual out of pocket maximum change?
    Are there changes to the doctor, hospital, or nursing facility copays?
    Are there any changes to the out-of-network copays?
    Are there any changes to the extra benefits?

Note that sometimes the answers to the questions about prescription drug coverage may be found in the drug formulary that came with the ANOC and not in the ANOC itself.

Scam Alert

Every so often we get emails regarding the latest Medicare-related scam circulating our the Idaho, Oregon, Washington, Utah, and Montana region.  The most recent one involves diabetic supplies.  In short, Medicare beneficiaries are getting calls from a diabetic supplier who is informing them that as of July 1, 2013, many suppliers of diabetic supplies are going out of business.  This company, however, is not going out of business and will gladly offer to be your new supplier.  Although this scam pales in comparison to many of the other ones we see, it did prompt us to write this article.  While tips to avoid every insurance scam ever imagined would fill volumes of books, we’ve boiled it down to five general rules that will get you past most any scam.

1. Make sure you know who your coverage is through.  We recommend writing the names of your insurance companies down on a piece of paper and sticking them on your refrigerator or somewhere you see often.  If you have a Medicare Supplement (e.g. Bankers Fidelity, Mutual of Omaha, or Continental Life), your Prescription Drug Plan is mostly likely with another carrier (e.g. Humana, First Health Part D, AARP United Healthcare).  If you have a Medicare Advantage Plan (e.g. True Blue, Pacific Source, Regence MedAdvantage) your health and your prescription coverage will likely be combined into one policy.
2. Don’t respond to anything.  If you receive anything (letter, post card, flyer, etc.) that looks like it’s from Medicare or your insurance company, DO NOT respond using the information provided.  Instead, call Medicare directly (800-633-4227) or your insurance carrier, depending on who the scammer is trying to impersonate. 
3. Don’t give out personal information.  If you get a phone call from Medicare or your insurance carrier, and they begin asking you personal information, hang up.  If you’re afraid that it may have been a legitimate call, simply place a call to Medicare or your carrier telling them that you received a call from them and wanted to see if there is anything they need.  Most carriers will NEVER ask for personal information over the phone.
4. Look for promises and pressure.  One common tactic of scammers is, ironically, to appeal to our fear of getting ripped off.  If there is some deal with loads of promises that sounds too good to be true, it probably is.  While there have been several changes to Medicare in the last few years, there is nothing new that is going to take away all your problems.  Also, be wary of anything or anyone that is trying to get you to act RIGHT NOW!  Any deal that is going to expire soon (like before they get off the phone) is not legitimate.
5. Use us.  If you ever get a call or receive something in the mail that sounds or looks fishy, don’t ever hesitate to drop us a call (800-817-9223) or email.  Often in just a few minutes, we can help you discern whether you’re in a situation that actually requires something from you, or whether you’re holding a 8½ x 11 inch waste of time.

The above relates specifically to insurance; below are some helpful links to avoid other types of scams. 

Idaho Attorney General

FBI Fraud Schemes

What about hearing aids?

Every so often we get questions about hearing aids.  Does Medicare cover them?  If not, will my insurance cover them?  If not, can I buy stand-alone hearing insurance?  And not surprising either, since hearing aid costs can range up to $10,000 for a set.  So what’s the scoop?

First, Medicare does not cover hearing aids.  Medicare will cover hearing and balance tests when ordered to treat you for a medical condition, but not to determine a need for hearing aids.  Since Medicare Supplements are bound by law to only fill in the gaps within Medicare (and not provide extra coverage), they are unable to pay for hearing aids.  Some people choose to receive their Medicare benefits via a Medicare Advantage Plan rather than through Original Medicare hoping to receive extra benefits.  However, most Medicare Advantage Plans in Idaho do not include hearing benefits either, and those that do typically only cover one hearing exam per year, and offer no coverage for hearing aids. 

However, all hope is not lost!  There is the option to purchase a stand-alone hearing insurance coverage.  While these policies aren’t just falling off trees, we do have one option in Idaho.  It is a combination Dental-Hearing-Vision policy and offers up to $2,000 per year in benefits.  The best part about this coverage is that it allows you to see any dentists, optometrist, or audiologist you wish, unlike many plans that restrict you to a network of providers.  This can prove to be a huge advantage in that it allows you to shop all kinds of retailers, including large discount chains like Costco where prices can be half of those found at hearing aid specialty stores.  If you would like more information about this coverage, please call or email us anytime at:  800-817-9223 or info@tweedyinsurancegroup.com.

Annual Election Period

Today marks the first day of the Annual Election Period.  What, you may ask, is the Annual Election Period?  The Annual Election Period, or AEP, is a window of time during which you can change the way in which you receive your Medicare benefits and in which you can add or drop prescription drug coverage.  Here are some quick pieces of info. 

• Begins.  The AEP begins on October 15th of each year.
• Ends.  The AEP ends on December 7th of each year.
• Effective Date.  Any changes made during the AEP will be effective January 1st of the following year.
• Medicare Advantage.  During the AEP you can change from Original Medicare to a Medicare Advantage plan (or vice versa), or you may change from one Medicare Advantage plan to another.
• Prescription Drug.  During the AEP you can add, drop, or change prescription drug coverage.
• Applications.  If you apply for a prescription drug plan or Medicare Advantage plan and decide that you would like another plan, you may make another selection.  In fact, there is no limit to the number of applications you can submit during the AEP.  If you do submit more than one application, the last one submitted is the one that sticks. 
• Medicare Supplements.  The AEP does NOT effect Medicare Supplements at all!  A Medicare Supplement does NOT have to renewed each year, nor will it change from year to year.  If you have a Medicare Supplement, October 15th is just another day in October.
• Marketing.  The above explains why you may have noticed a sudden up-tick in the amount of marketing material you've been receiving lately :)  Not to worry.  If you have any questions about making a change to your Medicare Advantage or prescription drug coverage, please feel free to call (800-817-9223) or drop us an email (info@tweedyinsurancegroup.com) anytime.

Annual Notice of Change (ANOC)

Hey look - more acronyms!  The federal government loves acronyms, and even when they work together with private industry (as is the case with PDPs and MA Plans) they still abound like they're going out of style.  So what is the Annual Notice of Change (ANOC)?  Do I get one?  Does it even matter?

The Annual Notice of Change is a document that Prescription Drug Plans (PDPs) and Medicare Advantage Plans (MA Plans) send out each fall to inform you of the changes in your plan.  If you don't have a PDP or an MA Plan, then no, you will not get one.  But for everyone else, expect to see this arriving on your doorstep sometime around the first of October.  Now we come to the $64,000 question - does it matter?

Yes.  I know, I know.  You wanted me to say no.  But the truth is, this is a very important document.  Why?  Each year a PDP or MA Plan files a new contract with the federal government.  This contract is totally different from the prior year's and can change items such as copayments, deductibles, monthly premiums, and even covered drug lists.  Because these changes can be so drastic, the plan is required to send you an ANOC to inform you of the differences between the current year and the upcoming year. 

So now you're probably all excited to read through your ANOC, right?  Well that will probably only last until it arrives.  Depending on your plan, your ANOC will weigh between 5 and 6 tons and come with it's own pillow.  Okay not really, but you get the drift.  While the whole publication does have merit, we have some tips to help you use this document efficiently.  So below are some questions that we would suggest you answer before just deciding to toss (or drag) it out.

For PDP plans:

• Did the monthly premium change?
• Did the drug copayments change?
• Are there any significant changes to the list of participating pharmacies?
• Are there any changes to the list of covered drugs that effect you?
• Are there any additional restrictions on the drugs that you're taking?

For MA plans, ask the following questions in addition to the above:

• Did the annual out of pocket maximum change?
• Are there changes to the doctor, hospital, or nursing facility copays?
• Are there any changes to the out-of-network copays?
• Are there any changes to the extra benefits?

Common Insurance Terms

Ha, you think!  The only thing common about insurance terminology is that they're all confusing.  We understand.  After all, insurance terminology is the second cousin to legalese!  Trying to read through a Summary of Benefits, or other health insurance material can be an exercise in frustration if you don't know the lingo.  That's why we've put together the following guide: Insurance Terminology in Plain English. 

Because we love simplicity, this isn't an all-inclusive guide of every insurance word ever used.  But, it will hit many of the most commonly used terms.  If you'd like to dig a little deeper, check out the two links below.

• A Glossary of Medicare Terms (c) Medicare Interactive
• Medicare.gov/Glossary

Lock-In

The Medicare Lock-In.  A very ominous sounding phrase, but what is it?

In short, the Lock-In refers to the time of year when, generally speaking, a Medicare Beneficiary is unable to change from Original Medicare to a Medicare Advantage Pan (or vice-versa) or change their Prescription Drug coverage. 

As you may know, there are only two ways to receive your Medicare benefits; either through Original Medicare (Part A & Part B) or through a Medicare Advantage Pan (Part C).  However, Medicare no longer allows a beneficiary to change back and forth between the two at will.  Instead, Medicare requires that once you make your decision, you stick with it for one calendar year.  During the Annual Enrollment Period (that runs from October 15th through December 7th) you are able to choose between the two.  Your decision will take effect on January 1st, and you will be "locked-in" to that decision until December 31st. 

Likewise, you may use the Annual Enrollment Period (AEP) to add, drop, or change your prescription drug coverage (Part D).  This change also takes effect on January 1st and continues throughout the entire year. 

But as with all things government, there are exceptions.  Countless exceptions.  These exceptions are called Special Election Periods (SEPs).  If you are unhappy with the plan that you are currently on and would like to see if you qualify for an SEP, please give us a call (800-817-9223) or shoot us an email and we can let you know what your options are.

MADP Ends Feb 14th

So what is MADP?  MADP stands for "Medicare Advantage Disenrollment Period".  Medicare Advantage Plans have certain windows, or election periods, in which you can enroll, disenroll, or make changes.  The main election period is the Annual Election Period which occurs between October 15th and December 7th.  Last year Medicare created another election period -  the MADP.  This period allows someone enrolled in a Medicare Advantage Plan (MA Plan) to disenroll and return to Original Medicare.  Here are some general guidelines about what you may and may not do during this time.

• A member may leave an MA Plan that includes drug coverage, thus returning to Original Medicare, and enroll into a stand-alone Prescription Drug Plan.
• A member may leave an MA Plan that does not include drug coverage and return to Original Medicare, but cannot enroll into a Prescription Drug Plan.
• A member may NOT change MA Plans.
• A member may NOT add a Prescription Drug Plan.

When a member returns to Original Medicare there may be an opportunity to purchase a Medicare Supplement which can cover many, if not all, the Medicare copayments and coinsurance.  Although most Medicare Supplement providers require a short health questionnaire to be completed, there are many circumstances that may allow a person to purchase a supplement without ANY medical underwriting.  If you have questions about this enrollment period, or if you would like to see if you qualify for a Medicare Supplement, please call (800-817-9223) or email (info@tweedyinurancegroup.com) us - we'd love to chat with you any time.

Medicare Enrollment Periods for Plan Year 2012

This year changes have been made to the Medicare Enrollment Periods.  What is a Medicare Enrollment Period?  If you are enrolled in a Medicare Advantage Plan or a Prescription Drug Plan, there are only certain periods during the year in which you may make changes to your plans.  Baring any special circumstances these periods are as follow:

• Annual Election Period: Oct 15th - Dec 7th. During this period you may enroll or disenroll from a Medicare Advantage Plan or a Prescription Drug Plan. All changes during this time will be effective Jan 1st.


• Medicare Advantage Disenrollment Period: Jan 1st - Feb 14th. During this time period you may only disenroll from a Medicare Advantage Plan and return to Original Medicare. You may add a Prescription Drug Plan to replace the drug coverage that your Medicare Advantage Plan afforded.

There are small nuances to the above periods, as well as many other "Special Election Periods" If you feel that you may have a special circumstance that would allow you to enroll or disenroll from a Medicare Advantage Plan or Prescription Drug Plan and you would like to speak with us more about your potential options, please feel free to call (800-817-98223) or email (info@tweedyinsurancegroup.com) us anytime.