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Medicare Open Enrollment: Common Patient Questions—Answered

Medicare Part D Open Enrollment: Common Patient Questions—Answered by Elements magazine | pbahealth.com


October 5, 2016


Are your patients prepared for Medicare Open Enrollment?

With the Open Enrollment period quickly approaching, it’s important to be able to answer any questions patients may have.

Medicare can be confusing for patients to understand, but as an independent community pharmacist, you can help make navigating Medicare Part D coverage for your patients a little easier.

Here are some of the most common questions patients ask about Medicare, and how to answer them.

What is the Open Enrollment period for Medicare?
Medicare Open Enrollment is the annual enrollment period when patients can enroll in Medicare for the first time, drop coverage or make changes to their plans.

When is the Open Enrollment period?
The Medicare Open Enrollment period for 2017 coverage begins in the fall of 2016. It runs Oct. 15 through Dec. 7. Coverage begins on Jan. 1 of 2017.

Who is eligible for Medicare Part D?
Anyone with Medicare can get prescription drug (Part D) coverage, including people ages 65 and older who are U.S. citizens or permanent residents, and people below the age of 65 who have certain disabilities.

How do I sign up for Medicare Part D?
Once you choose a plan, you can enroll in it on the Medicare Plan Finder or on the plan’s website. You can also complete a paper enrollment form, call the plan or call 1-800-MEDICARE.

When can I make changes to my plan?
You can make changes to your plan during the Open Enrollment period, which lasts Oct. 15 through Dec. 7. This includes signing up for the first time, dropping coverage or switching between plans.

What are my options for switching plans?
You can switch from Original Medicare to Medicare Advantage, or vice versa. You can also switch from one Medicare Advantage plan to another, or from one Medicare Part D plan to another.

How much does Medicare Part D cost?
The cost of Medicare Part D varies depending on the drugs you use, the plan you choose and whether you qualify for Extra Help.

Payments typically include a monthly premium, yearly deductible, copayments or coinsurance and a coverage gap.

What is the late enrollment penalty?
You may owe a penalty if you go without a Medicare Part D plan or other creditable prescription drug coverage for a continuous period of 63 days or more.

The penalty is added to your monthly Medicare Part D premium. The penalty amount depends on how long you went without Medicare Part D or creditable prescription drug coverage, and it may increase each year.

Do I need to renew my plan each enrollment period?
No. If you’re already enrolled in a Medicare Part D plan and you don’t want to make any changes to your coverage, you don’t need to do anything during Open Enrollment.

If your plan is being discontinued, or if your plan is ineligible for renewal, you’ll receive a non-renewal notice prior to Open Enrollment.

Although you don’t need to renew your plan, it’s important to be aware of and understand any changes being made to your current coverage to ensure it’s still the best plan for you.

What if I have full Medicaid coverage and I am eligible for Medicare?
Medicare should automatically enroll you in a drug plan if you don’t join one on your own. Medicare Part D will provide most of your prescription drug coverage, but Medicaid may also add to the Medicare drug coverage for some drugs.

What if I receive other help to pay prescription costs and Medicare automatically enrolls me in a plan?
If you receive other creditable prescription drug coverage, that’s at least as good as Medicare’s, you may not want to keep the drug plan you are automatically enrolled in.

If you would like to opt out of the plan or switch plans, you can do this during the Open Enrollment period.

What if my spouse or I have prescription drug coverage from a current or former employer or union?
Employers and unions who provide prescription drug coverage should notify you about how your coverage compares to Medicare Part D.

In some cases, you can join a Medicare plan in addition to your employer or union coverage. However, in other cases, you or your spouse may lose your employer or union coverage if you enroll in a Medicare Part D plan.

It’s important to speak with your benefits administrator to see what the effect of Medicare Part D enrollment would be on your current coverage.

Learn more about Medicare Part D.

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