New to Medicare?
The Medicare Open Enrollment period runs from October 15 to December 7. Anyone with Medicare Coverage can make changes to their Medicare Advantage coverage during this period. Those changes go in affect January 1st of the following year. You can add, drop or change plan coverage. The following tips will help you navigate this busy season:
Question: Will I lose my Medicare coverage if I enroll in an Advantage Plan?
Answer: No. You remain in the Medicare system and the advantage of enrolling in a Medicare Advantage Plan is the insurance company becomes your primary payer of healthcare. When coverage is effective with an Medicare Advantage Company, simply use the ID card you are mailed (not your red, white and blue Medicare card) and present it to contracted Health providers. If for any reason, you are not happy with chosen Medicare Advantage Company, you always have the option to revert back to Original Medicare during either the Annual Enrollment Period (AEP) which is October 15th to December 7th or the Annual Dis-enrollment Period (ADP) from January 1st to February 14th.
Question: I am not in the 12 month period following my first enrollment in a Medicare Advantage Plan. Can I disenroll before the Annual Enrollment Period (Oct. 15 – Dec. 7th) and change to another Medicare Advantage Plan?
Answer: No. You can only enroll or disenroll at certain times of the year during Medicare enrollment/disenrollment periods. You can disenroll and revert to Original Medicare during the Annual Disenrollment Period which is January 1st to February 14th otherwise you must wait for the next Annual Enrollment Period.
Question: When can I get Part D?
Answer: During your Initial Enrollment Period, or during the Medicare defined enrollment periods that happen annually (the Annual Enrollment Period), or if you qualify for a Special Enrollment Period.
Question: If I miss my chance or Initial Enrollment Period with Part B when is my next chance to sign up?
Answer: Your next opportunity to sign up will be during the Annual Enrollment Period which is January 1st to March 31st with coverage starting July 1. For each 12-month period you delay enrollment in Part B, you will have to pay a 10% penalty (most cases permanent) unless you have insurance from your or your spouse’s current job
Question: Are my prescriptions covered?
Answer: Your drugs (Part D) may be covered if you choose one of the plans with prescription drug coverage. Specific plan information will be available starting Oct. 1st. Review the formulary to see which drugs are covered by each company.
Question: What can I do if my prescriptions are not covered?
Answer: Members have the right to request a formulary exception for coverage either of non-formulary drugs or formulary drugs at a less expensive Tier. Also you can ask your provider to see if there is a comparable drug that is covered.
Question: Can you guarantee that a request for an exception will be approved?
Answer: We cannot guarantee an exception will be approved. It may depend on the prescription, quantities, if you have completed Step Therapy and other criteria (for example the class of the drug). However, your doctor can advise if there are other options available on the formulary that will work for you. You can chose to pay out of pocket if we do not cover the drug.
Question: May I use a physician outside the Medicare Advantage Companies Health network?
Answer: Your PCP would need to get authorization for a referral to providers outside of the Health provider network. The referral will only be approved when certain conditions are met, otherwise you will be redirected to an in-network provider. Contact your PCP or customer service for more information.
Question: What is the difference between an HMO and a PPO?
Answer: HMOs (Health Maintenance Organizations) and PPOs (Participating Provider Organizations) both have a contracted network of doctors which guarantees access to care for their members. PPOs differ in that they typically permit you to use non-contracted providers but at a higher out of pocket costs. HMOs generally require you to use services in network while having lower out of pocket costs.
Question: If I have VA benefits, do I need to sign up for a Medicare Advantage Plan?
Answer: Some veterans choose to sign up for a Medicare Advantage Plan as this allows them to see doctors off base and allows them access to more hospitals.
Question: Do I have to change my doctor?
Answer: Probably not. With many doctors in the networks in the counties service area, there is a good chance your provider is contracted with one of the Medicare Advantage Companies Health Plans. But be sure to verify your doctor is in network prior to choosing that plan.
The Medicare Open Enrollment period runs from October 15 to December 7. Anyone with Medicare Coverage can make changes to their Medicare Advantage coverage during this period. Those changes go in affect January 1st of the following year. You can add, drop or change plan coverage. The following tips will help you navigate this busy season:
Question: Will I lose my Medicare coverage if I enroll in an Advantage Plan?
Answer: No. You remain in the Medicare system and the advantage of enrolling in a Medicare Advantage Plan is the insurance company becomes your primary payer of healthcare. When coverage is effective with an Medicare Advantage Company, simply use the ID card you are mailed (not your red, white and blue Medicare card) and present it to contracted Health providers. If for any reason, you are not happy with chosen Medicare Advantage Company, you always have the option to revert back to Original Medicare during either the Annual Enrollment Period (AEP) which is October 15th to December 7th or the Annual Dis-enrollment Period (ADP) from January 1st to February 14th.
Question: I am not in the 12 month period following my first enrollment in a Medicare Advantage Plan. Can I disenroll before the Annual Enrollment Period (Oct. 15 – Dec. 7th) and change to another Medicare Advantage Plan?
Answer: No. You can only enroll or disenroll at certain times of the year during Medicare enrollment/disenrollment periods. You can disenroll and revert to Original Medicare during the Annual Disenrollment Period which is January 1st to February 14th otherwise you must wait for the next Annual Enrollment Period.
Question: When can I get Part D?
Answer: During your Initial Enrollment Period, or during the Medicare defined enrollment periods that happen annually (the Annual Enrollment Period), or if you qualify for a Special Enrollment Period.
Question: If I miss my chance or Initial Enrollment Period with Part B when is my next chance to sign up?
Answer: Your next opportunity to sign up will be during the Annual Enrollment Period which is January 1st to March 31st with coverage starting July 1. For each 12-month period you delay enrollment in Part B, you will have to pay a 10% penalty (most cases permanent) unless you have insurance from your or your spouse’s current job
Question: Are my prescriptions covered?
Answer: Your drugs (Part D) may be covered if you choose one of the plans with prescription drug coverage. Specific plan information will be available starting Oct. 1st. Review the formulary to see which drugs are covered by each company.
Question: What can I do if my prescriptions are not covered?
Answer: Members have the right to request a formulary exception for coverage either of non-formulary drugs or formulary drugs at a less expensive Tier. Also you can ask your provider to see if there is a comparable drug that is covered.
Question: Can you guarantee that a request for an exception will be approved?
Answer: We cannot guarantee an exception will be approved. It may depend on the prescription, quantities, if you have completed Step Therapy and other criteria (for example the class of the drug). However, your doctor can advise if there are other options available on the formulary that will work for you. You can chose to pay out of pocket if we do not cover the drug.
Question: May I use a physician outside the Medicare Advantage Companies Health network?
Answer: Your PCP would need to get authorization for a referral to providers outside of the Health provider network. The referral will only be approved when certain conditions are met, otherwise you will be redirected to an in-network provider. Contact your PCP or customer service for more information.
Question: What is the difference between an HMO and a PPO?
Answer: HMOs (Health Maintenance Organizations) and PPOs (Participating Provider Organizations) both have a contracted network of doctors which guarantees access to care for their members. PPOs differ in that they typically permit you to use non-contracted providers but at a higher out of pocket costs. HMOs generally require you to use services in network while having lower out of pocket costs.
Question: If I have VA benefits, do I need to sign up for a Medicare Advantage Plan?
Answer: Some veterans choose to sign up for a Medicare Advantage Plan as this allows them to see doctors off base and allows them access to more hospitals.
Question: Do I have to change my doctor?
Answer: Probably not. With many doctors in the networks in the counties service area, there is a good chance your provider is contracted with one of the Medicare Advantage Companies Health Plans. But be sure to verify your doctor is in network prior to choosing that plan.
