Marci’s Medicare Answers: Fall Open Enrollment details

Dear Marci,
What is Fall Open Enrollment? —Dana

Dear Dana,
Fall Open Enrollment occurs each year from Oct. 15 to Dec. 7. During Fall Open Enrollment, people with Medicare can make changes to their Medicare coverage with their new coverage taking effect Jan. 1 of the following year. Outside of this time, people with Medicare generally cannot make changes to their Medicare coverage unless certain circumstances qualify them for a Special Enrollment Period.
During Fall Open Enrollment, people with Medicare can do the following:
—Switch from Original Medicare to a Medicare Advantage plan.
—Switch from a Medicare Advantage plan to Original Medicare.
—Switch from one Medicare Advantage plan to another Medicare Advantage plan.
—Switch from one Medicare prescription drug plan to another Medicare prescription drug plan.
—Join a Medicare prescription drug plan for the first time.
Before making any changes during Fall Open Enrollment, it may be helpful for you to take a look at your current Medicare coverage to see whether your benefits and costs will change in 2014. If there aren’t any changes to your Medicare coverage and you’re satisfied with your coverage, you don’t need to make any changes during this time.
However, if there are changes to your Medicare health and drug coverage or you are unsatisfied with your Medicare coverage, you have the right to make changes during this time.
You can make as many changes to your Medicare coverage during Fall Open Enrollment, but keep in mind that your last coverage decision made during this time will take effect Jan. 1, 2014. To avoid enrollment problems, it’s best to call 800-MEDICARE when making any changes to your Medicare health and/or drug coverage. —Marci

Dear Marci,
I plan on switching from a Medicare Advantage plan to Original Medicare during Fall Open Enrollment. Can I also sign up for a Medigap plan during Fall Open Enrollment? —Kara

Dear Kara,
Whether you are allowed to buy a Medigap plan during Fall Open Enrollment depends on your circumstances and your state’s specific rules on Medigap enrollment.
A Medigap plan is supplemental coverage designed to pay for out-of-pocket Original Medicare costs, such as deductibles and coinsurances. Medigap plans do not work with Medicare Advantage plans. You can only have a Medigap plan if you have Original Medicare.
Under federal law, you have the right to buy a Medigap plan at certain times. Federal law allows people 65 years or older to buy Medigaps; however, some states may extend that right to people who are under 65 years old and become eligible for Medicare due to disability, end-stage renal disease or Lou-Gehrig’s Disease (ALS). For exact rules and protections in your state about Medigap enrollment periods, contact your State Health Insurance Assistance Program or State Department of Insurance. —Marci

Dear Marci,
I received a grey notice in the mail that said I would no longer automatically qualify for Extra Help. What does this notice mean? —Karl

Dear Karl,
Extra Help is the federal assistance program that helps pay the cost of prescription drugs for those with limited finances.
Sometime in the fall, certain people with Medicare may receive grey Extra Help notices from the Social Security Administration. This grey notice informs people that they will no longer automatically qualify for Extra Help, beginning the first of the following year.
Generally, people who receive this grey Extra Help notice automatically qualified for the program in the past by having Medicaid, a Medicare Savings Program or by receiving Supplementary Security Income. The grey notice is sent to individuals who will no longer qualify for Extra Help in the upcoming year, because they no longer qualify for Medicaid, have a Medicare Savings Program or no longer receive Supplementary Security Income.
People with limited income and resources may still qualify for Extra Help. However, they must apply directly to Social Security to continue receiving the benefit. They can do so by filling out the application attached to the grey notice or by visiting online at https://se cure.ssa.gov/i1020/start. —Marci

EDITOR’S NOTE: Marci’s Medicare Answers is a service of the Medicare Rights Center, www.medicarerights.org.

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