As individuals retire or age into Medicare, their insurance situation can change dramatically. There are a multitude of options open to those with Medicare. The terms are different, the prices are different, the products offered are dramatically different each year.
The purpose of this column is to give those who are eligible for Medicare, or soon to be eligible for Medicare, some understanding of their insurance options and how it could impact their health and finances.
These questions and answers are meant as a guide to help you understand the complex questions you are now thinking about. Each individual's specific situation may create a different solution. You shouldn't necessarily do what your friends, family and neighbors do.
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Janell Sluga
Q: I know the date to change my drug plan is Dec. 7, but what do I do if I miss that?
A: The media coverage for this year's Annual Open Enrollment Period (AEP) of Oct. 15 to Dec. 7 has been extensive. It is hard to imagine missing all the ads in the newspaper, magazines and TV. I know that some of you have not done anything yet. I know that because my phone is still ringing.
You have until midnight on Friday to make your insurance change. If you have already made a choice and now have changed your mind, you can do a new enrollment. The last enrollment you do before Friday is the plan enrollment that you will have. You should still get your information prior to Jan. 1. If you need to fill a prescription in January before you get your ID card, you can call the company you chose and see if they have you on file yet. If you call your new 2013 company they will give you your ID numbers. You can take this information to your pharmacist and he or she can fill your prescriptions using your new plan.
If they don't have you in the system yet, you may need to fill the prescription anyway, pay full price and then file a claim with the company to get back any money you are due.
If it gets to be close to the end of December and you haven't heard from your chosen company, please call them. That will give you and the company enough time to figure out the problem in order to get you enrolled and processed by Jan. 1.
Remember that most people complete their enrollment through the Center for Medicare & Medicaid Services (CMS). Most people use the medicare.gov website or the 1-800-medicare phone number to facilitate their enrollment (1-800-633-4227). This means that Medicare is collecting the enrollment, but is sending it on to the insurance company to process. This communication takes time. Yes, computers are fast, but there are many thousands of Medicare recipients making these changes right now.
Medicare will then communicate the disenrollment to your 2012 insurance plan. It may take them a while to get this information to take you out of their computers. You may continue to get information from your old company for a number of months, which you ignore. You do not need to contact your old plan and disenroll. In fact you shouldn't contact them to disenroll; Medicare does that for you.
I don't recommend waiting until the last week, but sometimes our situations fall in such a manner that you can't help waiting until the last week or even the last day.
Please don't fill your prescriptions using your 2012 plan if you in fact switched plans for 2013. If you do this, the old company will then come back to your pharmacy for the money it paid on your behalf. Then your pharmacists will have to contact you to get your new information and re-bill the correct plan. This makes extra work for the pharmacists (who have enough work already). This also really confuses the insurance companies about your actual intentions. Did you mean to switch plans for the new year? Do you want to stay with your 2012 plan?
As with any change we need to make, I don't recommend procrastinating until the last moment, so if you can, make the change early. You may also have special enrollment periods open to you to make a switch later on in 2012 and 2013. That is another article to be done soon.
Happy insurance season to all and to all good health.
Janell Sluga is a geriatric care manager certified and works for Senior Life Matters, a program of Lutheran Senior Housing, and has worked in Chautauqua County with seniors for more than 18 years. She is HIICAP (Health Insurance Information, Counseling & Assistance Program) counselor-trained by Office for the Aging. She does not sell insurance or represent any insurance company. She is an unbiased source of insurance and education to help seniors choose the best option for them.
You may submit questions to be answered in later columns to Janell Sluga at Senior Life Matters, 737 Falconer St., Jamestown, NY 14701, or call 716-720-9797, or by email at janells@lutheran-jamestown.org.
Please remember that not all questions can be answered in this format, but as many as can be, will be.