By Nelva Hernandez
Becoming Medicare eligible is a major milestone. Many people will move from employer-based insurance to Medicare, which will likely be their health insurance for the rest of their lives. New Medicare enrollees will have to choose their Medicare coverage – Part A (hospitalization), Part B (medical), Part C (Medicare Advantage) and Part D (prescription drug coverage) – and decide if they will add a supplemental insurance plan (Medigap). Deciding on the best coverage is an individualized process. One size does not fit all, and the choices made at initial enrollment can have consequences years later.
Beneficiaries often need help understanding the Medicare program and their options. Alexandria’s Virginia Insurance and Counseling Program provides free, unbiased counseling to help Alexandria residents navigate through the initial enrollment and annual Medicare changes. The VICAP Program is managed by the City of Alexandria’s Division of Aging and Adult Services and supported by certified volunteers. The program offers individualized free consultation to Alexandria city residents to help them make the most informed decisions since Medicare coverage can change from year to year.
Each year, Medicare has an open enrollment period from Oct. 15 to Dec. 7. During this time, enrollees should review their plan to decide if it still meets their needs. Enrollees in a Medicare Advantage Plan (Part C Medicare) and those participating in prescription drug plans (Part D) can elect to keep their current plan or enroll in a new plan. Any changes made during this open enrollment period will be effective Jan. 1, 2021.
Each year, Medicare Part C and D Plans make changes to their plans. A plan may discontinue and beneficiaries may be automatically enrolled into another plan that does not meet their needs. Plans may change the drugs they cover. Your medication may cost you more or your plan could discontinue covering a medication, leaving you responsible for the full cost of that drug, if you remain enrolled.
Your current Part C or Part D plan will send you an annual notice of change in September to notify you of changes to plan costs and coverage for the following year. Pay attention to changes in drug formularies – the list of drugs covered by your insurance – drug pricing tiers, deductibles and copays for the drugs you take. Ignoring this notice and not checking to see if your plan is still the best fit can be a costly mistake.
It is also very important to review your summary notices and report any suspected Medicare fraud or abuse to Senior Medicare Patrol at 1-800-938-8885.
This fall, beneficiaries should receive notification of upcoming changes to the Medicare Program. These changes will be effective January 2021. Changes in 2021 include the ability for individuals with end stage renal disease diagnosis to enroll in Medicare Advantage plans. Another major change is that Virginians under the age of 65 will be able to purchase Medigap supplement insurance.
The Alexandria VICAP program offers free telephone counseling or web-based counseling to navigate all of these changes and can answer questions about coverage, enrollment, changing plans and resolving problems. In addition, counselors can help assess eligibility for programs that can assist with paying premiums and drug costs.
During open enrollment, counselors can assist residents with checking to see if their plan is still the best fit.
Trained counselors can create a plan analysis and review it with beneficiaries. Beneficiaries can get started by submitting a personal information form and list of medications online at www. alexandriava.gov/aging or call the intake line at 703- 746-5999 to request a copy of the form.
The writer is coordinator of Alexandria’s Virginia Insurance and Counseling Program.