Thursday, September 19, 2013

Medicare Open Enrollment vs Affordable Care Act Open Enrollment

October 1, 2013 is the beginning date for the "Open Enrollment" in the newly created Health Care Exchanges and Marketplaces that have been enacted under the Affordable Care Act (ObamaCare).  

Our blog from August 21, "What Are These Exchanges All About?" details the 2013 Health Care Marketplace for all insured and non-insured looking for new coverage. However, even if you are happy with your existing coverage, you may find the new system to be even better and offer additional coverage at a reduced rate. Everyone should be exploring all their available options now.

Unrelated to the Affordable Care Act, the Medicare population also has the opportunity to change their Medicare coverage during the Annual fall Open Enrollment (AEP) beginning October 15 until December 7,  for a January 1, 2014 effective date.  This is an area we previously addressed in our October 26, 2012 blog. 

So, how do you know whether to choose traditional Medicare with a Medicare Supplement that offers a Prescription Drug Plan or choose a Medicare Advantage plan with Prescription drugs included?  Asking the following questions could be helpful in making the most appropriate decision.
  1. Were you satisfied with your Medicare coverage this past year?  If you were satisfied with your Medicare coverage, perhaps you need not make any changes.  If, on the other hand, you had problems with accessing providers in your Medicare Advantage Plan or wished you could go out of network to see any physician you wanted, then you may want to consider a change.
  2.  Do you anticipate high utilization of services next year? (tests, procedures, surgery, etc.)   If yes, then a change from your present Medicare Advantage Plan to traditional Medicare may be warranted.  The cumulative cost of co-pays and co-insurance under Medicare Advantage Plans can be greater than the costs of a Medicare supplement and stand alone Part D drug plan. 
  3. Did you enter the prescription drug doughnut hole?  If you are presently enrolled in a stand alone Part D plan you should do an analysis of your present drugs to see which Plan is best for you. Plan D programs are very drug specific and what worked for you this year may not be beneficial for you next year. Formularies, co-pays and premiums are different from Plan to Plan.
  4. Are you planning to move from your present residence next year?  A move to another location could be a problem if you are enrolled in an Advantage Plan. Out of network services are generally not available. Check with you Plan to see if they have a program in your new area if you still wish to be enrolled in an Advantage Plan, rather than the traditional Medicare program.
The official Medicare website,, gives excellent instructions on how to further best select the most appropriate Plan D option, evaluate Medicare plans and understand what Medicare covers. If you're enrolled in a Medicare Advantage and/or Part D Plan, you should  receive an Annual Notice of Change by September 30th.  This notice informs you if your current provider network and drug formula will change. These changes may help you decide whether or not to shop for alternate plans for the coming year.

Stay Informed. Stay Positive. Stay Healthy.
- The Patient's Advocate 

A service provided by 
Claims Security of America

1 comment:

  1. If your physical and/or mental health is declining (you or your loved one has diminishing physical or mental capacity and may have to go into nursing home or assisted living) you might want to consider switching from a Medicare Advantage plan back into traditional medicare since the advantage plans cover very few (and not the best rated) facilities.