Annual Medicare Enrollment Period

Top 10 Things You Need To Know

Yes, there will be changes—but don’t worry. With our help, you’ve got this.

1. During the Annual Enrollment Period (AEP) you can join, change or drop (disenroll) from your Medicare Advantage HMO. You also can join, change or disenroll from your stand-alone Part D prescription drug plan. The changes will start January 1, 2019.

If you don’t make any changes, your current plan will simply roll over on January 1. From January 1 through March 31, there will be a new Medicare Advantage Open Enrollment period during which members can make one change.

2. Open your Annual Notice of Change (ANOC) pamphlet as soon as you get it. The ANOC is sent by your current Medicare HMO and/or Part D prescription drug plan, and will arrive mid-September through October 1. If you’re happy with your current doctors, your health plan and your coverage, you’ll need to open the ANOC and examine any changes between your 2018 benefits and the upcoming 2019 benefits. Health plans do change; confirm your physicians and preferred hospital will still be available in your plan in 2019, and whether your plan is adding or deleting any benefits. If you have Original Medicare, you won’t get an ANOC, but you will get a Medicare and You 2019 handbook—also around the end of October. It will explain broadly how Medicare works, highlight any changes for 2019 and tell you which services are covered by your Medicare plan.

3. Pay close attention to what the ANOC says about your prescription drug costs. Your costs may not be the same in 2019 as they were in 2018. Be especially aware if you are taking more expensive brand-name drugs. Some might be moved to a higher “tier,” meaning they will cost more. Some might be cleared for generic. Some people started to pay more for their prescriptions later in 2018 because of entering the “coverage gap” (AKA “the donut hole”), which means they have spent a certain amount for covered drugs and are required to pay more until the new year starts. The good news is the lower drug costs start over again on January 1. But it’s likely you will enter the coverage gap in 2019 about the same time as you did in 2018.

4. Consider changing to (or sticking with!) a Medicare Advantage HMO that offers an array of options and is contracted by an independent provider such as Torrance Memorial IPA, especially if you are looking for local access to a dedicated Member Service representative and the ability to self-refer to specialists.

5. Pay attention to special coverage you might need or wish to have in the future, such as routine vision, hearing aids, acupuncture, routine chiropractic, discount dental and/or over-the-counter mail order benefits.

6. Check out the MOOP. MOOP stands for “maximum out of pocket.” It’s one of the things that often changes in a new-year plan. Medicare Advantage HMOs all have a MOOP, which typically ranges from $1,500 to more than $3,400 each calendar year. MOOP is the limit of a member’s copayments or coinsurance for any given year, and once it’s reached you will no longer have to make copayments or coinsurance.

MOOP does not involve prescription costs—only medical services. MOOP often becomes a concern for cancer patients because, in most cases, patients with Medicare Advantage HMO pay 20% of their chemotherapy treatments until they reach their MOOP for the calendar year. MOOP also becomes a concern if a person stays in a skilled nursing facility longer than 20 days.

7. Do be careful when changing HMOs; it’s not a frivolous decision. For instance, if you are changing to save a $20 copayment on an urgent care visit with one HMO to another HMO with a $0 urgent care copayment, you need to realize there may be another item where you might pay more. Other benefits such as the mail-order option or outpatient mental health benefits might be vastly different. If you are seeing a specialist or acupuncturist or taking a brand-name drug, for example, they might not be covered in the new plan.

Also make sure you are taking advantage of your current Medicare Advantage HMO plan benefits. Are you really using the complimentary gym membership benefit? Or the mail-order, over-the-counter benefits credit? Review your policy details in the Evidence of Coverage (EOC) document, which arrives in the ANOC mailing.

8. Torrance Memorial hosts live Medicare 101 classes, both on campus and now online via Facebook Live. The classes are moderated by Norman Panitch, MD, once a month and provide great detail on Medicare rules and options. This is not only a good class for people new to Medicare but also a terrific refresher course for anyone on Medicare. Visit Torrance Memorial IPA.org for the schedule.

9. There are other times throughout the year you can make changes. If you have been a bit overwhelmed by the decisions you need to make—say choosing a physician or medical group or Medicare HMO—you still can make one change between January 1 and March 31, the Medicare Advantage Annual Open Enrollment Period.

There also are many Special Enrollment Periods, such as when you move out of the service area for your HMO or experience a sudden drop in income. Check with Medicare, your insurance company or your insurance agent anytime throughout the year if you feel there is a need to change your insurance.

10. Medicare.gov is the official Medicare website and will be updated with 2019 insurance information by October 1. Medicare costs are typically announced by the government in November. Medicare.gov is a convenient way to shop for different HMO plans or stand-alone drug plans. You can also call the insurance companies directly to request information, or consult with an independent insurance agent.

What is Medigap?

Medicare Supplement plans (also known as Medi-gap), are offered by insurance companies to help cover costs beyond Original Medicare Parts A and B. These plans require you to pay monthly premiums and allow you to use any Medicare participating doctor or hospital in the US. Premiums depend upon age and extent of coverage, and you must also purchase a Part D prescription drug plan. Combined monthly premiums typically range between $100 and $300. To save on premiums, consider nonprofit Torrance Memorial IPA, which is not a Medigap, but charges no additional premiums and includes more than 500 excellent South Bay doctors. To use an IPA such as THIPA, first sign up for an HMO, then select a primary care doc who is with the IPA you want.

You can find help!

Medicare is tricky, and you want to make decisions you’ll be happy with for a year.

For Medicare information call Torrance Memorial at 310-257-7239 or go to medicare.gov or medicareinteractive.org. For questions about Torrance Memorial IPA please call 310-257-7239.

If you already are a Torrance Memorial IPA member, contact your member services office at 310-257-7250 and press 1 to speak to a representative. Or contact an agent, such as Vince Kelly, 310-625-1837 (medicarebabyboomer.com), or Rose Straub, 310-715-2300 (ymainsurancesolutions.com) for a free consultation.

Or make an appointment for free Medicare counseling with a health insurance counseling and advocacy expert, call Doris Herzog at 310-517-4666. Sessions are held on Thursdays.