SHINE: Serving the Health Insurance Needs of Everyone

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Written by Lorraine York-Edberg, Western Mass. Regional SHINE Program Director

Published: October 12, 2018

Medicare Open Enrollment is open and ends on December 7

Lorraine York-EdbergIf you have a Medicare, sometime during the month of September you should have received important information known as an Annual Notice of Change from your Prescription Drug Plan or your Medicare Advantage Plan HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization). The mailing explains any changes to your plan in the coming year regarding premiums, drug coverage changes (formulary), providers, and restrictions. It is very important to review the information to make sure the plan still works for you.

Starting October 15 through December 7, you can join, drop, or change your insurance, and the new coverage will begin on January 1, 2019. I like to call this time of year “Your Annual Insurance Checkup,” because it is a time when you can evaluate your current plan and decide if you want to make changes. If your current plan continues to meet your needs, then you may want to keep it. It is also a time when you may want to shop around for a new plan to help you save money, decrease or increase coverage.

Important things to consider when reviewing your plan changes are:

• Does it still cover all your medications?
• Are there any restrictions on your medication like quantity limits, prior authorization or step therapy that would make it difficult to access your needed medications?
• Did you get a letter from your Medicare Prescription Drug Plan that your plan is changing or is no longer available in Massachusetts?
• Have you been reassigned to a new plan? If so, contact the new plan to assure it will cover your current medications. If not, you should join a new plan before December 7, 2018, to access the medications you need without any problems.
• Would you like to join a Medicare Prescription Drug Plan or Medicare Advantage Prescription Plan? Because [JR1] you’ve never joined previously, you can do it during this time.

Review and save all letters from your plan!

During the Medicare Open Enrollment (October 15 - December 7), you will have an opportunity to CHANGE your coverage for next year. You can decide to stay in Original Medicare or join a Medicare Advantage Plan. If you are already in a Medicare Advantage Plan, you can use the Open Enrollment to switch back to Original Medicare with a Medicare Prescription Drug Plan. State-certified SHINE (Medicare) counselors can help you understand your plan changes, as well as other options you may have. Call early to get a SHINE appointment (1-800-498-4232) during Open Enrollment!

Ways to get the help you need:

• Visit www.medicare.gov/find-a-plan to use the Medicare Plan Finder.
• Look at your most recent “Medicare and You” handbook to see plans in your area; 2019 books will be mailed late September.
• Call 1-800-MEDICARE (1-800-633-4227) and say, “Agent.” Help is available 24 hours a day, including weekends.
• Contact your local SHINE Program.
• Attend a local presentation regarding the annual Open Enrollment period.

The SHINE program, Serving the Health Insurance Needs of Everyone, provides confidential, and unbiased health insurance counseling for Medicare beneficiaries. This is a free service, though contributions are welcome and will go a long way to help support this vital program. For further assistance with any Medicare issue, you can make a SHINE appointment. To reach a trained and certified counselor in your area, contact the regional office at 1-800-498-4232 or 413-773-5555, or contact your local council on aging.