Department of Human Services

Medicare Open Enrollment

5 Things You Need To Do

November 3, 2015 | 5 min reading time

cmslogo


Routines help keep us focused, organized and even healthy.  However, if your health routine doesn't include preparing for Medicare's Open Enrollment, now's the time to kick start a new healthy habit. 

If you have a Medicare health or prescription drug plan, Open Enrollment runs October 15, through December 7, and is the time you can make changes to your plan. Even if you're happy with your current coverage, you might find something that's a better fit for your budget or your health needs.  If you miss an Open Enrollment deadline, you'll most likely have to wait a full year before you can make changes to your plan.

 Here are five important things every Medicare beneficiary can do to get in the Medicare Open Enrollment routine. 

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 your state 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. 27 percent of people in Missouri with Medicare Part D get Extra Help (also called the low-income subsidy, or LIS).  You can find out if you qualify too, by visiting Medicare.gov or making an appointment with a local State Health Insurance Assistance Program (SHIP) counselor. The contact information is at the bottom of this article. 

4. Shop for plans that meet your needs and fit your budget.  Starting in October, you can use Medicare's plan finder tool at Medicare.gov/find-a-plan to see what other plans are offered in your area.  A new plan may: 
a. Cost less 
b. Cover your drugs 
c. 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, or join a different Medicare Advantage plan.  You can even change your Prescription Drug Plan during this time.

 5. Check your plan's star rating before you enroll. The Medicare Plan Finder has been updated with the 2016 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. 

Additional Information to Know: 

  •  Thanks to the Affordable Care Act, more people with Medicare are seeing reduced costs through discounts on brand-name and generic drugs in the Medicare Part D "donut hole".  Before the Affordable Care Act, when a drug plan had paid so much on behalf of the beneficiary the beneficiary was then responsible for the entire costs of the drugs until they reached a catastrophic limit of spending.  In 2016, if you reach the "donut hole" in Medicare's prescription drug benefit, you'll save 55 percent on covered brand-name drugs and see increased savings on generic drugs while in the donut hole. 
  •  Pay attention to letters that you get in the mail from your current plan, and our agency,  The Centers for Medicare & Medicaid Services. 
o A few Medicare beneficiaries may get a notice in the mail from their current Medicare Advantage Plan with prescription drug coverage that the plan they are in is no longer contracting with the Centers for Medicare & Medicaid Services, CMS, the federal agency that administers these programs.  If you get this notice, you should look at your options for a new plan.  If you don't take action before December 31, you will lose your prescription drug coverage and only have Original Medicare starting January 1, 2016.  Because your plan will no longer be offered, you can join a new plan anytime between October 15, 2015 and February 29, 2016.  If you don't join a plan with prescription drug coverage by February 29, 2016, you won't have prescription drug coverage in 2016 and you may have to pay a late-enrollment penalty if you join a Medicare prescription drug plan later.  If you are in a Medicare Advantage Plan without prescription drug coverage, and your plan is no longer contracting with CMS, and you are already enrolled in a separate prescription drug plan, your prescription drug coverage will not be affected by this change. 

o A few Medicare beneficiaries may get a notice in the mail from their current Medicare Advantage Plan with prescription drug coverage that the plan they are in is no longer contracting with the Centers for Medicare & Medicaid Services, CMS, the federal agency that administers these programs, but that they will be enrolled in a different plan by the same insurance company.  If you get this notice, and want to look at your other options, this is the time of year to do that. 

o In late October, one letter that some beneficiaries will receive is blue.  This is for some low-income subsidy beneficiaries who qualified to receive extra help in paying some of their out of pocket prescription drug costs.  This letter informs auto-enrollees into the low-income subsidy plan for low income beneficiaries that because their current Medicare drug plan premium is increasing above the regional low income premium subsidy amount, they'll be reassigned to a new Medicare drug plan effective January 1, 2016, unless they join a new plan on their own by December 31, 2015. 

o In early November, some beneficiaries will receive a tan letter.  This letter is for those low-income subsidy beneficiaries who qualified to receive extra help in paying some of their out of pocket prescription drug cost but who chose a Medicare Prescription Drug Plan on their own instead of being automatically enrolled in a plan.  This letter informs people who get Extra Help and chose a Medicare drug plan on their own that their plan's premium is changing, and they'll have to pay a portion of their plan's premium in 2016 unless they join a new $0 premium plan. 

These are a few easy ways to get a jump start on your Medicare Open Enrollment. For help and more information you can: 

  • Call 1-800-MEDICARE (1-800-633-4227), and say "Agent." TTY users should call 1- 877-486-2048.  Help is available 24 hours a day, including weekends.  If you need help in a language other than English or Spanish, let the customer service representative know the language. 
  •  You can also call your State Health Insurance Assistance Program (SHIP) for free one- on-one personalized counseling and non-biased Medicare assistance. 
    •  In Missouri that is the Community Leaders Assisting the Insured of Missouri, (CLAIM), program, and their toll free number is: 1-800-390-3330.
Also, ask them about a Medicare enrollment event near you. The SHIP programs in every state offer enrollment events during Open Enrollment to help Medicare beneficiaries look at their options and enroll in a different plan.  Call your State SHIP program for the event information, an appointment and what to bring.

 Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter @CMSgov 

# # #
  • Department:
    Department of Human Services
  • Topic:

Was this page helpful?      



Comments are helpful!
500 character limit

Feedback is anonymous.