The AEP season is upon us and now’s is the time that anyone wanting to make a change to their Medicare Advantage and Prescription Drug plan can do so. The deadline to submit a plan change is December 7th.
For those that don’t want to change their plan don’t need to do anything. The plans renew automatically, unless you’ve been informed otherwise by your plan.
What new benefits are we hearing about in the marketplace?
Healthy Food Grocery Cards
There are more and more plans offering Healthy Food card options to their Medicare Advantage members. This benefit allows members to buy healthy foods like fruits and vegetables at participating grocery stores up to the monthly allowance. For those Medicare beneficiaries that have Medicaid a lot of plans are adding this to their dual special needs (DSNP) plans, for those that have both Medicare and Medicaid.
For those without Medicaid, there are only a few plans in the Atlanta market that offer the Healthy Food Card. To be eligible for the grocery card you need to have a qualifying chronic condition (doesn’t apply to DSNP plans). We’ve attached a copy of the list of the SBBCI chronic conditions:
Some plans will have the benefit as a stand alone others are combining them with their Over-the-Counter (OTC) benefit. Meaning: they’ll give you a monthly allowance and you can either buy the OTC items or the healthy foods. Other plans have two separate allowances, one for OTC and another for healthy foods.
Continuous Glucose Monitoring (CGM)
We’ve heard that Medicare is now covering these devices more easily and thus Medicare Advantage Plans are too. The CGM offer a simple way to monitor your glucose. CGM automatically tracks your glucose levels day and night using a small sensor worn on the back of the upper arm and a monitor that lets you view your glucose levels at any time. Plans will cover these devices under the Durable Medical Equipment benefits.
Review Your ANOC
Make sure to review your Annual Notice of Change so you know what’s changing with your plan. Also don’t forget to review the formulary to make sure that the medications you take are still being covered, you’ll want pay attention to the tier level the medication is in as that will dictate how much you’ll pay.
Please don’t hesitate to reach out to us if you need help with reviewing your Medicare plan options. Happy AEP!
Almost another year has gone by and just around the corner the floodgates of Medicare marketing envelopes will begin. For some they technically haven’t stopped, you’ll just get more! Therefore, it’s important to know what paperwork to keep and what you can throw out. One document you’ll want to keep from your current health plan is the Annual Notice of Change or ANOC letter. Usually this comes in a booklet or folded into a letter but beefier then other envelops, expect it towards end of September.
As you’ll see in the below snapshot of an ANOC, there will be two columns to show you the differences from your current benefits and the upcoming changes for the following year. What you’ll likely not find in your ANOC is the changes to the formulary or the list of drugs that are covered by your Medicare Advantage or Prescription Drug Plan. If a medication you are currently prescribed is no longer going to be covered you should get a separate notification 60 days in advance, it will inform you of the medication no longer covered and posible alternatives to consider. Make sure you discuss these changes with your doctor or if you know you can’t switch medications perhaps you’ll need to have a formulary exception to have the plan continue to cover your medication or perhaps it’s time to shop for a new plan that will cover it.
In your ANOC don’t expect a new formulary, many times you’ll need to ask for this document (by calling customer service) or you can retrieve it from your health plans website, they will have them available no later than October 1st. Just make sure that when you are searching you are selecting the upcoming year documents, so for example this October you’ll want to search for 2022 formulary.
I find it’s easier to look for what you need if you register in your health plans website member portal. The link is likely right on your Member ID card. If you register you’ll be able to pull up your current plan documents, like your summary of benefits, formulary, claims activity and even a copy of your ID card if you happen to lose it. When my clients register to their member portal it makes it easy to research when ever there are questions regarding billing, we can easily see who has filed a claim with the health plan and who hasn’t. While that information can be discovered by calling customer service it helps to avoid the hold times.
What should you do after reviewing your ANOC letter?
I suggest you think about the past year and consider what benefits worked well and which you found to be either too expensive or didn’t cover you as much. Or it may be a good time to consider what treatments or coverage you’ll need for the up coming year. Perhaps you are considering a major surgery, dental work, maybe you’ll need new glasses or you are having a hard time paying for your groceries etc. Make sure to write these down so you don’t forget.
After you’ve identified some benefits that you may need, talk to your agent about them. It would be helpful to have your written list of concerns or benefits you think you’ll need for the upcoming year. Since there are many plans available it’ll help narrow it down to what is most important to you. Many times it may just be that you are on the best plan for you and thus you don’t need to make a change, other times there could be improvements on other plans that may offer you better benefits. Just make sure that you don’t forget to update your list of medications and doctors, that should always be reviewed before making any changes.
The 2022 plan year will include changes, that is certain. Medicare Advantage plans are continually offering new ways to keep their members healthy. Some benefits that are attractive are dental, vision allowances. Recently we’ve seen an increase in Medicare part B giveback plans, usually designed for people that are healthier. These plans will refund members part of what they pay for Medicare part B and it can be $50, $70 or more a month of refund. This refund gets put right into their social security check. Other clients have liked the healthy food cards, these are monthly allowances given to members to purchase healthy foods at their local grocery stores. Something new we’ve seen in recent years are plans offering in-home assistance with light chores, usually for those that meet certain health conditions and it’s limited to a few hours a week, but non the less helpful for great number of Medicare beneficiaries.
Are there any low income assistance programs to consider?
For some it would be a good time to review their financials and see if they qualify for any of the federal or state assistant programs. These include Extra Help or Low Income Subsidy, this program has 4 levels and it helps reduce the cost of medications for those that qualify. Ask your agent or contact social security to see if you qualify, you can also visit www.ssa.gov and apply it only takes 5-15 minutes. Another program which automatically enrolls you into the Extra Help program is the Senior Savings Program. This program is available through your home state Medicaid office, though many have the option to apply online too. With both these programs you do have to meet the eligibility requirements but doesn’t hurt to see if you qualify. The eligibility for them also changes every year so if you’ve tried in the past to apply and were not approved check again.
Our agency is here to help.
We are strictly a Medicare insurance agency, so we strive to be the best at helping our clients navigate the Medicare plan options. Our goal is to make it easy for you. Don’t have someone to help you navigate your plan options? Give us a call, we will be happy to help. Our agency has grown from just a few clients back in 2017 to over 700 clients in just 4 years. That is only possible because we work hard for our clients, we make it easy and we find them the best plan for their needs. We are not like those temporary agents that is in business one year and gives up the next, we are here to stay.
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Today all the Medicare Advantage and Prescription companies have released their 2020 plan benefits. For most the easiest way to review the changes to their current plan will be via their Annual Notice of Change (ANOC) letter. This letter was mailed out to all current members and should have arrived by 9/30/19. If you don’t have this letter or have misplaced it, you may contact your carrier to resend it or for many you will be able to access it electronically as many Insurers make them available in their websites.
The ANOC letter contains the plan benefit details for the following year. It’s an easy way of comparing your current plan with the changes coming up for 2020. Consult your agent to make sure that you understand the changes.
It’s important to do a medication cost comparison as the ANOC letters don’t give you a year by year comparison on what you can expect to pay. But it’s possible to compare your medication costs. Contact your agent to help you. There are drug price comparison tools on most Insurer websites, in addition Medicare.gov has their own. Note that it’s important that you provide the correct medication name (brand vs generic), how many you take a day, how often they are refilled (e.g., 30, 60, 90 a month, or every 3 months) and what pharmacy you go to refill them. All these details can change the cost projections significantly. ￼
For some Medicare beneficiaries their Insurer letters will notify them that their current plan will no longer be available for the following year. This is no cause for alarm, as there is plenty of time to review the options available. Some carriers will offer an alternative plan if they remove your plan from the market, the alternative option may come in a separate letter. But no matter what plan is selected, switching will require action on the part of the beneficiary. Talk to your agent to make sure that you select the plan that meets your needs.
Starting October 15th plan changes for AEP could be submitted to the Insurers, those changes will be effective January 1st 2020. For most the last day to submit applications for plan changes is December 7th.
Depending on your current needs other benefits may be more important. Think about what you may need for the following year. Perhaps you have a treatment or procedure coming up and you want to know what out of pocket costs you can expect.
Things you should compare:
Maximum out of Pocket
Network – HMO vs PPO
Referrals for HMO’s – do I need a referral to see a specialist?
Dental, Vision, Fitness, Hearing
Over the Counter (OTC)
Prescriptions – Are my medications still covered and what are the estimated cost projections?
If you like your current plan and you want to renew it with the changes you don’t have to take any action, the plan renews automatically.
Making a plan selection is very important and personal so let’s take our time to review the options, let’s ask questions and find the plan the fits your needs.
First I want to introduce myself, I’m Gabriel Liranzo a Medicare Broker Manager for one of the largest health insurance companies in the U.S. I oversee over 700 independent sales agents that sell Medicare Advantage (MAPD) and Prescription Drug Plans (PDP) in the Atlanta, GA area. My role requires (between other things) that I train, motivate and educate independent agents in the world of MAPD and PDP products.
I’ve been in the insurance business for 11 years now and I started in one of the most important roles health insurance companies have, a customer service representative (CSR). I believe that is one of the most important roles because that is the first point of contact for most members with an insurance company. I’ve moved through several positions in my career and they include, CSR senior lead (oversaw a team of 20 CSR’s), broker support for individual under 65 products, account manager for small group commercial products to my current role as a Medicare broker manager. So you could say I’ve been around the block when it comes to health insurance.
I’m also a full time father of three and husband of one beautiful lady. If you want to know a little bit more about me you can click on my profile picture. Check back later if you want to check out our family blog.
Now that you know a little bit about me let’s get started.
Ask Gabe: Take one.
My first topic comes directly from the field, one of my agents reached out to me because one of her clients has lost part B coverage! She wants to know what she could do to help him. So join me as we address her question.
1. Can a Medicare Advantage member who’s lost part B coverage for non payment of their part B premium reinstate their MAPD plan on July 1st?
The short answer is no but there are some exceptions (e.g. LIS). But don’t stop reading just yet as there is more to it. Let’s discuss this particular scenario so you can understand the reason for my response.
This agents client became eligible for part A and B of Medicare last year in 2016 when he turned 65, at which time he enrolled into part B (part A was automatically added as it is in most cases). He didn’t qualify for Extra Help or Low Income Subsidy (LIS) because of his income. When he became Medicare eligible he also enrolled into an MAPD plan or part C, he was so happy with his decision that he went on a long trip. Unfortunately he didn’t elect to have his part B premium deducted out of his social security check and as you can imagine while traveling he forgot to pay his Medicare part B premium. Yikes!
What were the consequences? His insurer had to terminate his MAPD coverage. Why? Well in order to enroll and stay an MAPD plan one must have Medicare part A & B and since he lost the latter he got the ax.
When the client learned that he lost his coverage he called Medicare frantically trying to reactivate his part B coverage. In the end he was able to successfully do it during the Medicare General Election Period (January 1st – March 31st). The problem is that he now has to wait until July 1st for his part B coverage to begin. Which now leaves us with the question at hand.
Where to find the answer.
The best resource besides askgabe.blog is the Enrollment and Disenrollment Guidelines MAPD that the Center for Medicare and Medicaid Services (CMS) issues out every year. It’s a pretty big document but it contains very valuable information, it’s basically the rules that MA and or PDP insurers must follow regarding enrollment and terminations. If you are having trouble sleeping, give those guidelines a read and you’ll find yourself drifting away quickly.
To navigate the 280 plus page PDF document there are three options, first there is the clickable index, second is pressing [Control+F] to open a search box where you can type key words you want to find and lastly, the non-recommend third option, scrolling forever till you find what your looking for.
The first area in the index I would click on is 50.2 – Required Involuntary Disenrollment because here you’ll have the proof that an MA company must terminate a member when they lose entitlement to part A or B of Medicare. From there you can navigate to section 50.2.2 where it gives additional details. See screenshot below.
The guidance is clear but for added reference you can click on Exhibit 14 and see a model template of the letter our client received. It basically contains almost the same language as above except that it includes when their MAPD plan is to terminate, a contact option if they believe the information is wrong and a heads up on enrolling into a Prescription drug plan (part D) so as not to incur a permanent penalty for not having creditable prescription coverage.
It’s important to highlight that in this model letter it doesn’t say that one is able to enroll back into an MAPD plan once they can reinstate their part B coverage, if that was an option it would clearly state it. It’s true one can enroll back into an MAPD during a qualifying SEP or the Annual Enrollment Period (AEP). The problem is that reinstating part B effective July 1st after losing coverage for non premium payment isn’t a qualifying SEP. There is an SEP for those that are enrolling into part B for the first time during the General Election Period but that’s not the scenario we are working with.
This bring us to the next question.
Is there anything we could do to help this beneficiary?
The short answer is yes. Since he lost creditable prescription coverage he is eligible to enroll into a PDP plan but he must do it within two months after his MAPD plans termination. How do I know that? For that I had to reference another SEP listed on a separate Enrollment and Disenrollment Guidelines specifically for PDP plans. It’s found in the same area you would find the one for MAPD plans, here is a link to make your life easier: Enrollment and Disenrollment Guidelines for PDP. Page 34 of this guidelines we will find the following SEP:
So while it may not be the solution we were hoping for, this does help the beneficiary get back his prescription coverage and avoid any permanent part D late enrollment penalties. So where does that leave us in regards to this client? Unfortunately he will have to wait until the AEP to enroll back into an MAPD plan effective 1/1/18. In the meantime he will have Part A and a prescription drug plan (if he used the SEP above) through June. Then come July he’ll have part B and will continue to have it until the end of the year.
Alternative SEPs worth looking into.
As I previously stated the Medicare beneficiary in our scenario didn’t quality for any SEP that would give him a break. But one should always check if one applies. On the E & D Guidelines there are several SEPs that could have granted enrollment into an MAPD plan effective July 1st, some include:
Low Income Subsidy – as long as one has Extra Help to pay for prescriptions they can enroll into an MAPD/PDP plan every month
Dual Eligibility, if one is eligible for Medicaid they also have a continual SEP
SEP for Enrollment Into a Chronic Care SNP plan – if beneficiary is eligible for a chronic plan they’ll have a one time SEP to enroll
Less likely SEPs could include:
Change in residency, a beneficiary moves to a new county where they are now eligible for new plans or where their current plan is not available
SEP to Enroll in an MA Plan, PDP or Cost Plan With a Plan Performance Rating of Five (5) Stars
The Medigap or Supplement route
If Medicare beneficiary doesn’t qualify for any SEP to enroll him during July 1st, he does have the option to enroll into a supplement plan. Note that they’ll be subject to the underwriting requirements but for many it’s a very viable option and definitely better than just Original Medicare.
So the moral of the story is, don’t forget to pay your part B premium otherwise you may have to contend with less than favorable health plan choices.