The annual open enrollment (AEP) for 2017 Medicare coverage begins in October 15 and ends on December 7, 2017. During the enrollment period the following changes can be made:

Change from Medicare Advantage to Original Medicare or from Original Medicare to Medicare Advantage
Switch from one Medicare Advantage plan to another or change from one Medicare Part D prescription drug plan to another
Enroll in Medicare Part D, but a late enrollment fees may be applicable

It is important to remember that to enroll in a Medicare Advantage plan there are basic criteria that need to be met, and these criteria are:

Plan holders must not have end-stage renal disease (exceptions apply)
Plan holders must be enrolled in Medicare Part A and Part B
Plan holders must reside in the plan service area

What if the holder of the plan does not want any changes? If the holder of the plan does not want to make any changes, then there is no need to do anything, provided the current plan is going to be available in 2017. If it is not, then the plan holder will receive a non-renewal notice from the insurance carrier before the AEP. No non-renewal notice? The plan stays in place.

Even if plan holders wish to keep their current coverage it does not mean that there are no new changes coming for the year. Check to see if the current plan is still the best option and find out about any changes. Make sure to clearly understand any changes that may apply to the insurance coverage.

It can be confusing for your regular and potential clients to keep the various annual election periods (AEP) straight. For Medicare Advantage/Part C and Medicare prescription drug plans there is an annual period to sign up, disenroll or change coverage for a plan. That period is October 15 to December 7.

However, if leads you are working with during this period did not sign up for one of those plans when they were first eligible for Medicare, referred to as their initial enrollment period, the AEP is their chance to make changes. Having said that, there is an exception to that general rule of thumb if the lead qualifies for a Special Election Period. (SEP)

What changes can your new and existing Medicare customers make during the AEP?

Even though your agency has sold and serviced Medicare plans for years, and frequently works with new leads, it never hurts to have good information on hand when speaking to customers. Education is a crucial part of your job.

In general, here is what existing and new Medicare customers may do during the AEP:

• Opt out of prescription drug coverage
• Enroll in a Part D prescription drug plan
• Switch from one drug plan to another
• Switch from Original Medicare, parts A and B, to Medicare Advantage
• Switch to Original Medicare from Medicare Advantage
• Switch from one Medicare Advantage plan to another

It’s important to note that any changes made during the open enrolment period do not go into effect until January 1 of the following year and your customers need to know that information.

The disenrollment period is January 1 to February 14 every year and new customers and converted leads can make changes during that period such as, switching to Original Medicare, Part A and B from Medicare Advantage.

The rules and regulations and dates and timing of when to start and stop or switch plans is considered to be one of the most frustrating things older Americans have to deal with every year. With the right approach to customer service, a thorough understanding of your products and the necessary educational component for your customers as part of your smart marketing plan, you are bound to garner numerous conversions from leads and keep existing clients happy.

If you are relocating to a new home that is within your Medicare plan’s service area, you will be able to keep your plan. However, if you are relocating to a place outside of the service area of your Medicare Advantage (Part C) or Part D plan, you will have to make changes. You will also need to make changes if the new location is covered by your plan, but you have access to other plans.

The period of time during which you can make adjustments to your plan is referred to as your Special Enrollment Period (SEP). Within this time frame, you can:

• Enroll in or modify your Medicare Advantage plan;
• Enroll in or modify your Part D drug plan; or
• Cancel your current Medicare Advantage plan and return to Original Medicare.

In order to make adjustments to your Medicare Advantage plan or Part D plan, you will have to learn about your new plan options in your new location. You can obtain information about these plans by visiting the Medicare website or the Medicare Plan Finder tool. In addition, you can find out about a certain plan by calling the private company’s customer service number.  

If you are eligible to receive both Medicare and Medicaid, you will have to contact the Medicaid program in the state in which you reside to learn about your options for Medicaid benefits. Pursuant to Medicare, if you inform your Medicare Advantage plan or Part D plan prior to moving, your SEP to replace your plan with another such plan starts the month before your move and continues up to two months following your move. If you inform your Medicare Advantage plan or Part D plan following your move, your SEP to change to another plan starts the month you reveal your plan, and two additional months afterwards.

Original Medicare includes Medicare Part A (hospital expenses) and Part B (other health care such as doctor’s office visits). The monthly premium for most participants is $104.90. Participants also pay “coinsurance” of 20 percent of most medical services.

Medicare Advantage, or Medicare Part C plans, are run by private insurance companies, and must offer comparable coverage to parts A and B. Some Medicare Advantage plans charge the same premium as Original Medicare, but many charge an additional premium. Most also charge coinsurance or a copay (a flat fee for a medical service), and these fees vary from plan to plan.

Original Medicare offers the widest choice of doctors and other health care providers. This may be particularly important to you if you like to travel. Original Medicare also has a lower monthly cost than most Medicare Advantage plans.

Most Medicare Advantage plans cover prescription drugs, which costs extra under Original Medicare. Medicare Advantage plans, by law, have a maximum out-of-pocket expense of $6,700 per year. This can give peace of mind, but most people’s out-of-pocket Medicare spending is far less than this amount. Some plans also offer vision, dental, assisted living and nursing home care, unlike Original Medicare.

The decision to go with Original Medicare or Medicare Advantage can only be made based on the particular terms of the Advantage plan that interests you. Because they are offered by private companies, Advantage plans vary widely in terms of their coverages, premiums, copays and coinsurance fees. Consider carefully the pros and cons of each option and consult with an expert if you need help deciding.

The elder law attorneys at Hook Law Center assist Virginia families with will preparation, trust & estate administration, guardianships and conservatorships, long-term care planning, special needs planning, veterans benefits, and more. To learn more, visit http://www.hooklawcenter.com/ or call 757-399-7506.

Medicare Advantage enrollees have through February 14, 2015 to withdraw from their Medicare Advantage plan and instead receive Medicare Parts A and B through Original Medicare. During this period, recipients can also join a Prescription Drug Plan (PDP) if necessary. There are some issues that individuals should keep in mind if they would like to withdraw:

• During the Medicare Advantage Disenrollment Period (MADP), it is not possible to switch to another Medicare Advantage plan – the only option is to go to Original Medicare coverage Part A and Part B. Those who would like to switch Medicare Advantage plans may do so during Fall Open Enrollment, which runs from October through December.
• Individuals returning to Original Medicare should consider how they might manage the deductibles, coinsurance and copayments they may encounter when seeking medical care and coverage. For example, individuals seeking to purchase a Medigap policy may face higher premiums or a waiting period.
• Keep in mind, if you drop other coverage (i.e. employer or union health care coverage), you may not be able to reinstate your coverage.

To learn more about these Medicare click here: http://www.medicare.gov/

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Individuals with Original Medicare should expect to continue the same level of care when they move. But if you also have a Medigap policy, be sure to touch base with your insurer. Your premium may change, based on your new location. Also, if you are enrolled in Medicare SELECT, you may need to buy a supplemental policy in order to use doctors and hospitals within the correct network.

If you are enrolled in Medicare Advantage, you should check with your plan to ensure that you will still be within its service area, and switch to a new area plan, if needed. If you decide to switch to the new area Medicare Advantage plan, you may do so under the special enrollment period, and get the new plan immediately, without an extended waiting period.

You may wish to switch to Original Medicare or to the Medicare Advantage plan which covers your new location. If you do nothing, you will automatically be enrolled in Original Medicare, which may mean you will need additional coverage for prescription drugs as well as a Medigap policy.

Christopher J. Berry is a Michigan elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.theeldercarefirm.com/ or call 248.481.4000