Marci’s Medicare Answers- MedicareRights.org

Dear Marci,

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 Period?

—Carlie

Dear Carlie,

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

Dear Marci,

What are some changes that will be made to Medicare in 2014 as a result of the health care law?

—David

Dear 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 hole.

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.

—Marci

Dear Marci,

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

Dear 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 drug costs. 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 www.shiptalk.org.

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. To learn more about different PAPs, you can go online and visit www.needymeds.org or www.rxassist.org.

—Marci

The Medicare Rights Center is dedicated to helping people with Medicare get the health care and medications they need and make the most of their Medicare rights and options. They also offer comprehensive services to help people with Medicare and their caregivers fully understand the options and sources of support that are available to them. Learn more on the website at MedicareRights.org