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."
I heard Medicare covers
preventive services. Does Medicare cover HIV screenings?
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
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
I received a notice from
my Medicare Advantage plan saying that it will no longer be offered in
2013. What are my options?
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.
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?
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'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
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