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Marci's Medicare Answers

Medicare Advantage Plan Out of Business? You Have Extra Time to Arrange New Coverage

Medicare Rights Center Q&A addresses HIV preventive services; 'benchmark' Part D and Extra Help

Dec. 11, 2012 - Although the Medicare Open Enrollment period ended on December 7, senior citizens who were enrolled in a Medicare Advantage Plan that ceased operation still have time to arrange for new Medicare coverage, according to "Dear Marci," a Q&A column on Medicare provided by the Medicare Rights Center.

Marci also explains that Medicare does offer HIV screening and it is free, as are the other preventive services in 2013. The column also explains the "Extra Help" offered by Medicare and the associated "benchmark Part D Plan."


Dear Marci,

I heard Medicare covers preventive services. Does Medicare cover HIV screenings?

—Denise


Dear Denise,

Yes, Medicare covers HIV screenings. HIV (human immunodeficiency virus) attacks the body’s immune system and may eventually lead to AIDS (acquired immunodeficiency syndrome). The HIV lab test screening is covered in full for an individual with Medicare once every year, if he/she asks the provider for it. The screening is also covered in full up to three times a year for pregnant women. The screening is performed as a lab blood test and must be prescribed by your doctor or health care provider.

Starting in 2012, Medicare private health plans, also known as Medicare Advantage plans, cover all preventive services in the same way as Original Medicare does. Medicare Advantage plans are not allowed to charge cost-sharing fees (i.e. copayments, coinsurances, and deductibles) for yearly HIV screenings. However, you will most likely need to see an in-network doctor in order for your plan to cover the full cost of the screening. Check with your plan to see what rules apply.

Keep in mind that anyone with Medicare can ask for the HIV screening test and receive it at no cost, but it is especially recommended that people at high risk for HIV be screened. For more information on HIV risk factors considered by the U.S. Preventive Services Task Force, click here.

—Marci


 

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Dear Marci,

I received a notice from my Medicare Advantage plan saying that it will no longer be offered in 2013. What are my options?

—Scarlet


Dear Scarlet,

Your plan should notify you if it’s leaving the Medicare program and ending at the end of this year. Since your plan is ending, you can choose your Medicare coverage for the upcoming year.

If you want Original Medicare in 2013, you will be automatically enrolled and your coverage will begin on January 1, 2013. You may sign up for a Medigap plan (a supplemental policy that helps pay for gaps in Original Medicare coverage) from October 2, 2012 to March 4, 2013, if you are 65 years or older. During this time, federal law gives people 65 or older the right to buy a Medigap policy and insurers cannot impose a waiting period on pre-existing conditions.

Some states are more generous with their Medigap laws and may offer these protections to people under 65. Contact your State Department of Insurance or State Health Insurance Assistance Program (SHIP) to learn more about Medigap rules in your state.

In addition, if you choose to be covered by Original Medicare in 2013, you can sign up for a stand-alone Part D prescription drug plan until February 28, 2013. However, you should try to sign up for a Part D plan by the end of this year so that you have prescription drug coverage effective January 1, 2013. If you wait until January or February to sign up for a Part D plan, your coverage will start the first of the following month after you enroll, and you may experience gaps in coverage.

If you want to enroll in a Medicare Advantage plan instead of Original Medicare, you can sign up for a new plan until February 28, 2013. However, it’s best to sign up for a new plan by the end of the year, so you can get coverage beginning January 1, 2013. If you wait until January or February to enroll in the new plan, your coverage will start the first of the month after you enroll. You will have Original Medicare with no drug coverage until your selected Medicare Advantage plan coverage starts.

—Marci



Dear Marci,

I have Extra Help. I spoke to someone from Social Security who told me that I am enrolled in a benchmark Part D plan. What is a benchmark Part D plan?

—Mitchell


Dear Mitchell,

Extra Help is the federal assistance program that helps people with Medicare with limited incomes pay for their prescription drug costs. If you have Extra Help, you may be automatically enrolled into a benchmark Part D plan. Extra Help will pay up to the federal benchmark amount on a Medicare Part D plan premium (the amount that you pay each month to have coverage). If you have Extra Help and you are enrolled in a benchmark Part D plan, Extra Help pays the entire cost of your Part D premium.

Keep in mind that you can have Extra Help and choose a Part D plan above the benchmark amount. However, you will most likely have to pay the remaining cost that Extra Help does not cover (i.e. any amount above the benchmark amount).

—Marci

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Marci's Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), and reports to be the nation’s largest independent source of information and assistance for people with Medicare. To subscribe to "Dear Marci," MRC's free educational e-newsletter, click here.

 

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