Ask the Expert – What do I Need to Know about Medicare’s Open Enrollment Period and the Affordable Care Act?

I read that the Medicare Open Enrollment Period is October 15- December 7, 2013. I am new to this and want to make sure I don’t miss anything. What do I need to know? Please see all my questions below in blue. Thanks!

Q. What is the Medicare Open Enrollment Period?
A. Medicare beneficiaries have the option to enroll in a Medicare Advantage plan (or switch plans) during the annual six-week open enrollment period. The Medicare Open Enrollment period for Medicare Advantage Plans (Part C) and Prescription Drug Coverage Plans (Part D) is from October 15th through December 7, 2013. Any change you make during the Open Enrollment period will take effect on January 1st, 2014.

Note: If you decide to stay with your current plan there is no further action required to renew it. Remember that if you don’t use this window of opportunity, you cannot make any changes to your coverage before October of the next year.

Q. How can I plan for Open Enrollment?
A. While Open Enrollment may seem a long time off, it will quickly be upon us.  Before Open Enrollment starts, here are a few things you should do to prepare and educate yourself on the changes you may or may not need to make to your Medicare Supplemental Insurance plan this year.
•    Call your doctor and schedule some of the preventative, no-cost health screenings and tests that are available for Medicare beneficiaries;
•    Take an inventory of your current prescription regimen and decide if your coverage is sufficient for the medicines you need;
•    Review plans and policies that are available in your area and decide if changing plans will save you money and better meet your needs.

To help with the planning, below are some important Medicare Open Enrollment Period dates:

-September 1-30, 2013    Review any notices from your plan about changes for the next year and compare plans to find one that meets your needs.
-October 15, 2013    Open Enrollment begins. This is the first day you can change your Medicare coverage for next year. It begins is the one time of year when all people with Medicare can make changes to their health and prescription drug plans for the next year.
-December 7, 2013    Open Enrollment ends. In most cases, December 7 is the last day you can change your Medicare coverage for next year.
-January 1, 2014    Your new coverage begins on January 1, 2014, if you switched to a new plan. If you stay with the same plan, any changes to coverage, benefits, or costs for the
new year will begin on this day.
-January 1–February 14, 2014    Between January 1–February 14, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you’ll have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.

Q. When deciding on a plan that is right for me, what do I need to know about the Affordable Care Act (ACA) if I have Medicare?
A.    Medicare isn’t part of the Health Insurance Marketplace established by ACA, so you don’t have to replace your Medicare coverage with Marketplace coverage.  No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now. You won’t have to make any changes.

Below are some positive ways Medicare beneficiaries are impacted by the ACA:
•    Medicare covers certain preventive services, like mammograms or colonoscopies, without charging you for the Part B coinsurance or deductible. You also can get a free yearly “Wellness” visit. Read our blog post “Are You Taking Advantage of the Free Preventative Services Provided Under the ACA?” for more details.
•    If you’re in the donut hole, you’ll also get a 50% discount when buying Part D-covered brand-name prescription drugs. The discount is applied automatically at the counter of your pharmacy—you don’t have to do anything to get it. The Donut Hole will be closed completely by 2020.
•    Your doctor gets more support. With new initiatives to support care coordination, your doctor may get additional resources to make sure that your treatments are consistent.
•    The ACA ensures the protection of Medicare for years to come. The life of the Medicare Trust fund will be extended to at least 2029—a 12-year extension due to reductions in waste, fraud and abuse, and Medicare costs, which will provide you with future savings on your premiums and coinsurance.

Read our blog post, Happy Anniversary to the ACA for more details on what the ACA means for seniors.

Q. Before I decide on a plan, one last thing. You mention in many of your articles that nursing homes in Northern Virginia cost $12-15,000 a month. That would be disastrous for my family, should my husband or I need long-term care in the future. Do any of the Medicare plans out there cover long-term care, at all?
A. It is important to understand that Medicare does not pay for long-term care. At most, Medicare covers 100 days of short-term rehabilitation that may take place in a skilled nursing facility. Read our recent blog post “Is Medicare Enough to Cover Mom’s Nursing Home Stay? ” for more details.

Just as you are planning for the Open Enrollment Period, you should plan for your future and for your loved ones. If you have a loved one who is nearing the need for nursing home care, call The Fairfax Medicaid Asset Protection Law Firm of Evan H. Farr, P.C. at 703-691-1888 to make an appointment for a consultation.

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.