Department of Human Services

Making Health Insurance Make Sense  October 2015

Answers to Some of the Most Commonly Asked Questions

September 25, 2015 | 4 min reading time
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Q:  Isn't it almost time for Medicare Open Enrollment?  Is that different from the Open Enrollment Period for the Health Insurance Marketplace?  If I already have Medicare Part D coverage, do I need to do anything?

 A:  Yes, Medicare Open Enrollment is starting on October 15, 2015, and continues until December 7, 2015.  That's different from the dates for the Health Insurance Marketplace, which has an Open Enrollment Period starting November 1, 2015, and runs until January 31, 2016.

 If you're already enrolled, and happy with your plan, you don't have to do anything.  But there could be big savings for you if you check into the choices you have for next year. That's because plans can, and often do, change from one year to the next.  Your needs could change, too.  For example, you might be taking new or different medicines now than you were a year ago.  If this is the case, it's especially important to look at your choices for 2016 while there's time to change if you want to.  

The plan you're enrolled in now will send out information to you about what changes it will make for 2016.  You should have this information by the end of September.  By then, the details of other plans available in your area will be posted on the Medicare.gov Plan Finder, so you can compare what you have with what other plans offer.  Many people can find a new plan with lower costs, or better coverage of their medications, or sometimes even both.  But if you don't go shopping, you may never know that something better is available.  

Need help in figuring this all out? Call us, at 1-800-MEDICARE [1-800-633-4227] anytime, 24 hours every day.  Or call your local State Health Insurance Assistance Program (SHIP) who can help you with a one on one appointment to look at your options.  Their number is on the back cover of your Medicare & You handbook. 

Q:  What about the Health Insurance Marketplace?  If I qualify for tax credits to cut the cost of health insurance, could that be a better option for me than my Medicare plan?

 A: The Affordable Care Act created the Health Insurance Marketplaces, and provides for tax credits to help reduce the cost of health insurance for many people whose income is less than four times the Federal Poverty Level –that computes to about $47,000 per year for a single person, or about $97,000 per year for a family of four.  

However, the Marketplace is not meant to replace Medicare, and if you are already on Medicare, you should not buy a Marketplace health insurance plan.  The Medicare plan you have now already includes substantial government help to keep the cost down for you, and you get at least some government help regardless of your income.  In addition, Medicare has lower deductibles and lower out of pocket costs than the typical coverage you can get from the Marketplace.  Finally, if the seller knows you are Medicare eligible, it is illegal for them to sell you a private Marketplace plan.  There are rare exceptions, but for nearly everyone on Medicare, the best option is to stay on Medicare.  The Marketplace also does not sell Medicare Supplemental polices, so this is not a place to shop for that coverage. 

Need help in figuring this all out?  Call us, at 1-800-MEDICARE [1-800-633-4227] anytime, 24 hours every day.  Or call your local trained counselors.  Their number is on the back cover of your Medicare &You handbook. 

Q:  During Medicare Open Enrollment periods, especially, fraudulent activity happens more often as Medicare beneficiaries are inundated with communications from organizations vying for their business.  What should Medicare beneficiaries know to help protect themselves from being a victim of Medicare fraud?

 A:  Health care fraud drives up costs for everyone in the health care system.  Fraud schemes often depend on identity thieves getting hold of people's Medicare numbers.  So guard your Medicare number.  Treat it as you would a credit card.  Follow these important steps to protect yourself from fraud: 

  •  Don't share your Medicare number or other personal information with anyone who contacts you by telephone, email or by approaching you in person, unless you've given them permission in advance.  Medicare will NEVER contact you for your Medicare number or other personal information. 
  •  Tell your friends and neighbors to guard their Medicare number. 
  •  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 services. 
  •  Be wary of salespeople who knock on your door or call you uninvited and try to sell you a product or service. 
  •  Don't accept items received through the mail that you didn't order.  You should refuse the delivery and/or return it to the sender.  Keep a record of the sender's name and the date you returned the items. 
 And if you're looking to enroll in a Medicare plan: 
  •  Be suspicious of anyone who contacts you about Medicare plans unless you gave them permission 
  •  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"
  • Any promotional items you're offered to enroll in a plan must be worth no more than $15, and these items can't be given on the condition that you enroll in a plan 
A common ploy of identity thieves is to say they can send you your free gift right away –they just need your Medicare number to confirm. Decline politely but firmly.  Remember, it's not rude to be shrewd! 

 Call 1-800-MEDICARE [1-800-633-4227] to report suspected fraud.  Learn more about protecting yourself from health care fraud by visiting www.Medicare.gov or by contacting your local Senior Medicare Patrol (SMP).  To find the SMP in your state, go to the SMP Locator at www.smpresource.org. 
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