Thursday, September 24, 2020

Open enrollment for Medicare starts soon. Are you ready? From October 15th – December 7th, enrollees have the opportunity to review their current coverage and decide whether to continue as-is or make a change for 2021. If you want to continue your current coverage, you don’t need to do anything, it will automatically be extended through 2021. If you make a change during open enrollment, it will take effect on January 1, 2021.

What is Medicare Part D?

Medicare Part D is a “standalone” drug plan that covers only prescription drugs. This plan is recommended if you are in traditional Medicare. Enrollees should receive an Annual Notice of Change from their current plan, which gives information about that plan for 2021 once it is announced.

Why should I consider a different drug plan?

  • Drug plans can change their premium, deductible, and copayments from year to year
  • The list of drugs they cover can change
  • The classification of each drug as generic or name brand, and as preferred or non-preferred; and usage restrictions can change
  • You might be taking a new drug

How do I find the drug plan that is right for me?

The best way to identify the drug plan that will cover your drugs at the lowest total cost to you is by using Medicare’s Plan Finder, a completely objective tool found at

After entering your drug information, the plan finder will:

  • Calculate the costs and tell you which plan would cover those drugs for the lowest annual total (the sum of all premiums and copayments).
  • Show what each drug will cost throughout the year
  • Note any usage restrictions on your drugs, and tell which pharmacies are preferred in the plan and what your costs would be at each pharmacy or by mail order
  • Tell what you will pay if under the various Medicare plans, subsidies and Medicare Advantage

If the Plan Finder shows that your current plan is the least expensive choice for 2021, you do not need to do anything. If you would like to change your plan, you can make the switch by calling the plan or using its website, or via the Plan Finder, or by calling 1(800)-MEDICARE.

What is a Medicare Advantage plan?

A Medicare Advantage (MA) plan is a health care plan that includes health maintenance organizations (HMOs), preferred provider organizations (PPOs), private fee-for-service plans (PFFS), special needs plans, and health savings accounts. The plans available to you depend on where you live.

How should I review my Medicare Advantage Plan?

  • Consider whether you have been satisfied with the care you received and the costs you incurred with your current plan
  • Consult the Annual Notice of Change that your plan will send you, which gives key information for 2021
  • Check to be sure that the doctors, hospitals, and other care providers you use will still be in the plan’s network or list of preferred providers
  • Check the plan’s charges for services you might need, including appointments with a primary care doctor or a specialist, hospital outpatient treatment, emergency room visits, or in-patient hospital stays
  • Compare your current plan to other plans offered in your area on these key components of health care

If I do not have a Medicare Advantage plan, what should I consider before enrolling?

  • First check whether your doctors and the hospital and other providers you might use are in the network, or are preferred, in any MA plan you are considering.
  • Check whether your MA plan offers any extra benefits, such as dental care, vision or hearing, or a gym or health club
  • Look carefully at the details of these benefits, such as restrictions on the provider you must use or dollar limits on the amount of the benefit

MA enrollees do not need a Medicare supplemental policy, also known as Medigap, which can reduce out-of-pocket costs. Consider all factors before giving up a Medigap policy you already have, since you might not be sure of getting it back if you later return to fee-for-service Medicare.

What Medicare services are covered during COVID-19?

The Centers for Medicare and Medicaid Services (CMS) has announced several new policies, and clarified others, in response to COVID-19. These are the services that will be covered during the pandemic.

  • COVID-19 Test: FREE to Medicare (fee-for-service – FFS) and Medicare Advantage customers
  • Vaccine: No vaccine is currently available, but if and when it is, it will be covered subject to deductible and co-payment rates by a Part D drug plan
  • Out-of-Network Care for COVID-19 Patients: Covered at in-network rates by Medicare Advantage plans
  • Pharmacies: More flexibility to use closer pharmacies or mail order – check with your plan
  • Telehealth: Covered under Part B for all FFS Medicare enrollees for ANY health condition, coverage varies for Medicare Advantage plans

What is the Senior Health Insurance Program (SHIP)?

The Senior Health Insurance Program (SHIP) offers free, objective assistance to Medicare enrollees facing these and other decisions. During the pandemic, most SHIP sites provide service by telephone or email. Most assistance will be by appointment, so call a SHIP site soon to book a time and to find out what information you need to assemble before your appointment.

Where can I get help with Medicare enrollment?

There are SHIP sites in each of AgeGuide’s eight counties region:

  • DuPage County: DuPage County Department of Community Services: (630) 407-6500
  • Grundy County: Grundy County Health Department: (815) 941-3121
  • Kane County: Senior Services Associates, Aurora: (630) 897-4035; Elgin: (847) 741-0404
  • Kankakee County: Catholic Charities, Diocese of Joliet: (815) 933-0111 ext. 266
  • Kendall County: Senior Services Associates: (630) 553-5777
  • Lake County: Catholic Charities, Archdiocese of Chicago: (847) 546-5733
  • McHenry County: Senior Services Associates: (815) 356-7457
  • Will County: Senior Services of Will County: (815) 740-4225

To find the location of other SHIP sites, click here.

How do I avoid scams?

Scammers are always at work, especially during open enrollment. Avoid scammers using telemarketing, social media, email, and door-to-door visits to try to sell phony COVID-19 tests and vaccines, hand sanitizer, wipes, and similar products. Never give your Medicare number to anyone other than your own doctors, pharmacists, or other trusted people who work with Medicare on your behalf, like SHIP counselors.

This handy infographic provides some tips to help you navigate Fall Open Enrollment

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