Medicare to Open Advantage Plan Disenrollment; Other
Key Information in Marci’s Medicare Answers
Marci’s Q&A has information about Medicare in the new
year that may be critical to some senior citizens: changing back to
original Medicare, changes in 2014, getting Extra Help
Dec. 27, 2013 – Although Medicare just closed “Open
Enrollment” earlier this month, there is a new “Disenrollment” period
about to open, when seniors enrolled in Medicare Advantage can switch to
Original Medicare. This and other important information about Medicare
in 2014 are explained below in the “Dear Marci” Q&A from the Medicare
I was told that I could switch from a Medicare
Advantage plan to Original Medicare during the Medicare Advantage
Disenrollment Period. What is the Medicare Advantage Disenrollment
The Medicare Advantage Disenrollment Period (MADP)
occurs January 1 to February 14 of each year. During this time, people
who have a Medicare Advantage plan, also known as a Medicare private
health plan, can switch to Original Medicare, the traditional Medicare
program administered by the federal government.
They may also sign up for a Medicare prescription
drug plan, also known as a Medicare Part D plan, to work with their
Original Medicare coverage. Any changes made during this time generally
take effect the first of the month following the enrollment change.
For example, if you switched from a Medicare
Advantage plan to Original Medicare and a Part D plan on February 1,
2014, your new coverage would begin March 1, 2014. Remember, people who
get their Medicare benefits through Original Medicare cannot make
changes during this time; only those who get their Medicare benefits
through a Medicare Advantage plan can switch to Original Medicare and a
Part D plan during the Medicare Advantage Disenrollment Period.
Before making any changes to your Medicare
coverage, be sure to think about your health care costs and needs. Also,
know that federal law may not give you the right to purchase a
Medigap plan if you disenroll from your Medicare Advantage plan and
enroll into Original Medicare.
Medigap plans are supplemental policies that can
help pay for out-of-pocket Original Medicare costs, such as deductibles
and coinsurances. You can only purchase a Medigap plan if you get your
Medicare benefits through Original Medicare. Keep in mind that certain
states may have more generous Medigap enrollment rules. For more
information on Medigap enrollment rules, contact your State Department
of Insurance or your State Health Insurance Assistance Program (SHIP). —Marci
What are some changes that will be made to
Medicare in 2014 as a result of the health care law?— David
The Affordable Care Act (ACA), also known as the
health care law, has made a few changes that have benefited people with
Medicare, such as the expansion of cost-free preventive services to
people with Medicare and the gradual closure of the Part D doughnut
In 2014, the ACA will continue to reduce the
doughnut hole, also known as the coverage gap. The doughnut hole is the
period of time in the calendar year during which the amount you pay for
your prescription drugs suddenly increases.
You enter the doughnut hole in 2014 when your total
drug costs (i.e. what you and your plan have paid towards your
prescription drugs) reaches $2,850. After both you and your plan have
paid this amount towards your prescription drugs in 2014, you will enter
the doughnut hole.
While you are in the doughnut hole, you will pay
less for generic drugs in 2014. Specifically, you will be responsible
for 47.5% of the cost of brand-name drugs and 72% of the cost of generic
drugs while you are in the doughnut hole in 2014.
Due to the ACA, the doughnut hole will be
completely phased out in 2020, meaning that people will not have to pay
more than 25% of the cost of their covered brand-name and generic
prescription drugs at any point during the year.
In addition, barbiturates (anti-anxiety drugs),
which were only covered by Medicare Part D plans for certain diagnoses
in 2013, will be covered by Medicare Part D plans in 2014, regardless of
what type of health condition you may have.
Note that while there are quite a few changes that
are occurring as a result of the ACA, such as the implementation of
Health Insurance Marketplaces, you should be aware that people with
Medicare should generally not sign up for Marketplace plans. If you have
questions about your Medicare benefits or coverage, you can always
contact 800-MEDICARE or go online and visit www.medicare.gov.
I was told that I would no longer qualify for
Extra Help this year. What are some other ways that can help me save on
my prescription drug costs?— Parsha
If you received a notice from the Social Security
Administration (SSA) saying that you would no longer qualify for Extra
Help, the federal drug assistance program that helps people afford their
prescription drugs, know that there may be other ways to save on your
Contact your State Health Insurance Assistance
Program (SHIP) to check whether there is a State Pharmaceutical
Assistance Program (SPAP) available in your state. These programs may be
able to help you pay for your Medicare prescription drug costs. However,
keep in mind that not all states have an SPAP.
In addition, eligibility rules and program benefits
vary by state. Contact your State Health Insurance Assistance Program to
ask about existing SPAPs in your state by going online and visiting
You may also want to take a look at drug
manufacturer assistance programs called Patient Assistance Programs (PAPs).
These programs vary depending on what type of prescription drug you
need. Note that not all drugs have related PAPs. In addition, each PAP
varies and may have different eligibility rules and program benefits.