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Understanding Open Enrollment

Medicare’s Open Enrollment is the time of year when you can make changes to your Medicare coverage. Medicare’s Open Enrollment runs from October 15 through December 7, and any changes you make will take effect on January 1, 2019.

During Medicare’s Open Enrollment, you can make changes to your health insurance coverage, including adding or dropping different types of Medicare coverage. The changes you can make include joining a new Medicare Advantage Plan or Part D prescription drug plan, switching from Original Medicare to a Medicare Advantage Plan, and switching from a Medicare Advantage Plan to Original Medicare. You can make as many changes as you want during this period, but only your last coverage choice will take effect in January.

Before making a decision about your 2019 coverage, consider the Medicare health and drug plan options in your area. You may be able to receive better health and/or drug coverage at a more affordable price. For example, even if you are satisfied with your current Medicare Advantage or Part D plan, you should check to see if there is another plan in your area that offers health and/or drug coverage at a better price.

Beginning in 2019, there will be these enrollment period changes:

  • If you have a Medicare Advantage Plan, beginning in 2019, you will be able to change your coverage between January 1 and March 31. During this time, you can switch from one Medicare Advantage Plan to another, or switch from a Medicare Advantage Plan to Original Medicare, with or without a Part D prescription drug plan. If you are enrolled in Original Medicare, you will not be able to make changes during this time.
  • If you have Extra Help to pay for prescription drugs, beginning in 2019, you will no longer be able to change plans once per month. Instead, you will have a Special Enrollment Period to enroll in or switch Part D plans once per quarter in the first three quarters of the year. The quarters are January through March, April through June, and July through September. If you make a change, your new coverage will begin the first day of the month following the month when you enroll.
To enroll in a new plan, you can call 1-800-MEDICARE, use the Medicare Plan Finder tool, call the plan directly, or get objective, one-on-one assistance from a GeorgiaCares counselor at 1-866-552-4464 (Option 4). 

What to do During Medicare Open Enrollment
  1. Review your plan notice. Be sure to read any notices from your Medicare plan about changes for next year, especially your “Annual Notice of Change” letter. Look at your plan’s information to make sure your drugs are still covered and your doctors are still in network. 
  2. Think about what matters most to you. Medicare health and drug plans change each year and so can your health needs. Do you need a new primary care doctor? Does your network include the specialist you want for an upcoming surgery? Is your new medication covered by your current plan? Does another plan offer the same value at a lower cost? Take stock of your health status and determine if you need to make a change. 
  3. Find out if you qualify for help paying for your Medicare. Learn about programs in Georgia to help with the costs of Medicare premiums, your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) deductibles, coinsurance and copayments and Medicare prescription drug coverage costs. You can do this by visiting Medicare.gov or making an appointment with a GeorgiaCares counselor. 
  4. Shop for plans that meet your needs and fit your budget. Starting in October, you can use the Medicare Plan Finder tool to see what other plans are offered in your area. A new plan may: 
    • Cost less
    • Cover your drugs
    • Let you go to the providers you want, like your doctor or pharmacy
    If you find that your current coverage still meets your needs, then you’re done. Remember, during Medicare Open Enrollment, you can decide to stay in Original Medicare or join a Medicare Advantage Plan. If you’re already in a Medicare Advantage Plan, you can switch back to Original Medicare.
  5. Check your plan's star rating before you enroll. The Medicare Plan Finder has been updated with the 2017 Star Ratings for Medicare health and prescription drug plans. Plans are given an overall quality rating on a 1 to 5 star scale, with 1 star representing poor performance and 5 stars representing excellent performance. Use the Star Ratings to compare the quality of health and drug plans being offered.
Source: www.cms.gov
Consider These 6 Things When Choosing Coverage
  • Costs: How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.
  • Coverage: How well does the plan cover the services you need?
  • Your other coverage: If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator or insurer before making any changes.
  • Prescription drugs: What's the plan’s overall star rating? What will your prescription drugs cost under each plan? Are your drugs covered under the plan's formulary? Are there any coverage rules that apply to your prescriptions? Are you eligible for a free Medication Therapy Management (MTM) program?
  • Doctor and hospital choice: Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network? Do you need to get referrals?
  • Quality of care: Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services? Get help comparing plans and providers.

Preventing Fraud During Medicare Open Enrollment

Medicare fraud is a year-round problem. Medicare Open Enrollment provides additional opportunities for identity thieves and scammers to take advantage of beneficiaries. 

You can protect your identity and help prevent health care fraud by guarding your Medicare card like you would a credit card. Identity theft from stolen Medicare Numbers is becoming more common. Medicare’s here to help by removing Social Security Numbers from Medicare cards and replacing them with a new, unique number for each person with Medicare. Medicare will mail new Medicare cards with the new numbers between April 2018 and April 2019.

Here are some important steps you can take to protect yourself from the identity theft that can lead to health care fraud:

    • Don’t share your Medicare Number with anyone who contacts you by telephone, email or in person, unless you’ve given them permission in advance. Medicare will NEVER contact you (unless you ask us to) for your Medicare Number or other personal information.
    • Don’t ever let anyone borrow or pay to use your Medicare Number.
    • Review your Medicare Summary Notice to be sure you and Medicare are only being charged for   actual items and services received.
If you’re looking to enroll in a Medicare plan:
    • Remember there are no “early bird discounts” or “limited time offers.”
    • Don’t let anyone rush you to enroll by claiming you need to “act now for the best deal.”
    • Be skeptical of free gifts, free medical services, discount packages or any offer that sounds “too good to be true.”

Source: www.cms.gov

Rules for Medicare Health Plans and Insurance Agents
All Medicare Advantage and Part D plans must follow strict marketing rules. Here are some tips on what plans can and cannot do.

  Think you’ve spotted a scam?
Report it to the FTC. If the scam is Medicare related, report it at Medicare.gov

More on Fraud
Federal Trade Commission: Avoiding Open Enrollment Scams

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Open Enrollment Help
For 24 hours service, 7 days per week: For local assistance in person or by phone:

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To prepare for your counseling session, please review the list of required information. For prompt service, have these items ready before you call or visit one of our locations. 

Social Security Numbers will be removed from Medicare cards to prevent fraud, fight identity theft, and keep taxpayer dollars safe. You can see the new card here. The Federal Trade Commission (FTC) has also released information on potential scams related to the new cards. 

Be sure to "Guard Your Card" and watch the video below for more information.