Things are about to heat up for Pam Muhlenkamp, but she’s ready.

As an Oasis-CLAIM Medicare counseling volunteer, Pam is prepared for a steady stream of older adults who will come to Barnes-Jewish West County Hospital in St. Louis, during Medicare Open Enrollment, which starts October 15 and lasts through December 7. They’ll be in search of help navigating a process that has a lot of moving parts. Pam is happy to be that friendly face to walk them through their options.

“There are so many things to know and so many decisions to make, especially if you are signing up for the first time,” says Pam. “I worked with a medical physicians group in software for nearly 30 years, and came to know a lot about Medicare. I like to solve problems, so I thought this would be a good fit.”

Pam, who also spends a lot of time with her grandchildren, and sings in a church choir, is looking forward to her fourth year as a Medicare counselor.

“One of the most common concerns people have is figuring out how they can make sure their expensive medicines will be covered,” she says.

Last year, Pam’s tenacity and know-how with the system made all the difference for a local woman whose sister signed up late for Medicare and misunderstood how her marketplace coverage fit into the equation. Thanks to Pam, the woman was finally able to help her sister get the coverage she needed, her penalty fees were waived and some refunds for costs incurred while she wasn’t covered will be recouped, at least in part.

Changes to watch for in 2019

Medicare counselors like Pam are trained regularly to be kept abreast of changes that happen from year to year with Medicare coverage. There are a number of things to know for 2019:

• Donut Hole Closing: An expensive element of the Medicare Part D prescription drug benefit requires enrollees with high prescription costs to pay more for their medicines after they reach a certain level of spending in one year. This creates a coverage gap – also called the “donut hole.” After a beneficiary’s out-of-pocket spending reaches a second threshold, they enter catastrophic coverage and pay substantially less. Under the Affordable Care Act (ACA), the donut hole was scheduled to close in 2020. But the spending bill Congress passed in March will close the donut hole for brand-name drugs in 2019. The gap will close for generic drugs in 2020.

• Therapy Cap Gone: Beneficiaries of original Medicare won’t have to pay the full cost of outpatient physical, speech or occupational therapy because Congress permanently repealed the cap that has historically limited coverage of those services.

• Better Information: Medicare is updating the handbook it sends to beneficiaries every fall. It will include checklists and flowcharts to make it easier to decide on coverage. The online Medicare Plan Finder tool will be easier to use and an improved “coverage wizard” will help enrollees compare out-of-pocket costs and coverage options between original Medicare and Medicare Advantage.

• More Telemedicine: Medicare is steadily broadening the availability of telehealth programs that let patients confer with a doctor or nurse via telephone or the internet. In 2019, it will begin covering telehealth services for people with end-stage renal disease or during treatment for a stroke.

• Lifestyle Support: Beginning in January, Medicare Advantage plans have the option to cover meals delivered to the home, transportation to the doctor’s office and even safety features in the home such as bathroom grab bars and wheelchair ramps. To be covered, a medical provider will have to recommend benefits such as home-safety improvements and prepared meals.

• In-Home Help: Medicare Advantage plans also will have the option to pay for assistance from home health aides, who can help beneficiaries with their daily activities including dressing, eating and personal care. These benefits represent a revised and broader definition of the traditional requirement that Medicare services must be primarily health related.

• Plan Test Drives: New regulations will let people try an Advantage plan for up to three months and, if they aren’t satisfied, they can switch to another Medicare Advantage plan or choose to enroll in original Medicare. Congress required this flexibility in the 21st Century Cures Act, designed to accelerate innovation in health care.

Effective starting in 2019, the Medicare Advantage Disenrollment Period will run from January 1 – March 31 every year. If you’re enrolled in a Medicare Advantage plan, you’ll have a one-time opportunity to do the following:

• Switch to a different Medicare Advantage plan
• Drop your Medicare Advantage plan and return to Original Medicare, Part A and Part B
• Sign up for a stand-alone Medicare Part D Prescription Drug Plan (if you return to Original Medicare). Most Medicare Advantage plans include prescription drug coverage already. Usually you can’t enroll in a stand-alone Medicare Prescription Drug plan if you already have a Medicare Advantage plan, but there are some situations where you can. Call your Medicare Advantage plan if you have questions.
• Drop your stand-alone Medicare Part D Prescription Drug

Oasis Medicare help is available in the St. Louis area

Our offices offer free and confidential help with Medicare questions. This unbiased counseling is provided by knowledgeable, state-certified Oasis volunteer insurance counselors and is a good option for individuals with first-time Medicare enrollment, claims assistance and plan changes.

To get help over the phone, call (800) 390-3330 (Missouri) or (618) 463-7182 (Illinois). To schedule a one-on-one appointment, call (314) 362-7587 (Missouri) or (800) 392-0936 (Illinois).

The State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance in all 50 states.

For more information, visit www.medicare.gov/.

If you have Medicare, you can protect your identity and help prevent health care fraud by guarding your Medicare card like you would a credit card.

Identity theft from stolen Medicare Numbers is becoming more common. Medicare’s here to help by removing Social Security Numbers from Medicare cards and replacing them with a new, unique number for each person with Medicare. Medicare will mail new Medicare cards with the new numbers between April 2018 and April 2019.

Here are some important steps you can take to protect yourself from the identity theft that can lead to health care fraud:

• Don’t share your Medicare Number with anyone who contacts you by telephone, email or in person, unless you’ve given them permission in advance. Medicare will NEVER contact you (unless you ask us to) for your Medicare Number or other personal information.
• Don’t ever let anyone borrow or pay to use your Medicare Number.
• Review your Medicare Summary Notice to be sure you and Medicare are only being charged for actual items and services received.

If you’re looking to enroll in a Medicare plan:

• Remember there are no “early bird discounts” or “limited time offers.”
• Don’t let anyone rush you to enroll by claiming you need to “act now for the best deal.”
• Be skeptical of free gifts, free medical services, discount packages or any offer that sounds “too good to be true.”

If someone calls you and asks for your Medicare Number or other personal information, hang up and call 1-800-MEDICARE (1-800-633-4227). To learn more about protecting yourself from identity theft and health care fraud, visit www.Medicare.gov/fraud or contact your local Senior Medicare Patrol (www.smpresource.org).

Courtesy of Centers for Medicare and Medicaid Services, 12/2017

The Medicare Open Enrollment period (October 15-December 7) is the time you can make important decisions for the coming year. Reviewing your coverage and what it means for your health and finances is time well spent.

Each year, insurance companies can make changes to Medicare plans that can impact how much you pay out-of-pocket—like the monthly premiums, deductibles, drug costs and provider or pharmacy “networks.” A network is a list of doctors, hospitals, or pharmacies that negotiate prices with insurance companies. They can also make changes to your plan’s “formulary” (list of covered drugs). Given these yearly changes, it is a good idea to re-evaluate your current Medicare plan each year to make sure it still meets your needs.

Why should you consider re-evaluating your current Medicare coverage?

• You can switch to better prescription drug coverage. Using Open Enrollment to switch your drug coverage—or add drug coverage for the first time—can make crucial medications that you need less expensive. It can also ensure that your drug plan still includes and covers the drugs you need.
• You can save money and keep your doctor in-network. Switching your Medicare Advantage or Part D plan can potentially save you hundreds of dollars a year—especially if your current plan’s out-of-pocket costs will increase next year.  One way to lower your medical costs is to check that your current doctors, hospital, and pharmacy are “in-network” with whatever Medicare Advantage or Part D plan you choose. If your insurance company has changed your plan’s provider or pharmacy network for next year (and your doctor or other resources will no longer be included), you can use Open Enrollment to switch to a plan that will include your current doctors, hospital and/or pharmacy in-network, thereby lowering your medical costs.
• You can find a higher quality plan. Finally, check the quality of your plan using the Medicare 5-star ratings system. Plans with a 5-star rating are considered high quality and those with fewer than 3 stars are considered poor quality. If your current plan is ranked as less than a 3, consider using Open Enrollment to switch to a higher rated plan.

(Excerpted from mymedicarematters.org, June 15, 2017.)

Find out more.

In Missouri and Illinois, Oasis offers free and unbiased assistance provided by knowledgeable, state-certified volunteer Medicare counselors. This is a good option for first-time Medicare enrollment, claims assistance and plan changes.

For information about these services, as well as how to access assistance in other states, visit https://www.oasisnet.org/National-Programs/Health-Programs/Medicare.

The Medicare Open Enrollment period (October 15-December 7) is the time you can make important decisions for the coming year. Reviewing your coverage and what it means for your health and finances is time well spent.

Each year, insurance companies can make changes to Medicare plans that can impact how much you pay out-of-pocket—like the monthly premiums, deductibles, drug costs and provider or pharmacy “networks.” A network is a list of doctors, hospitals, or pharmacies that negotiate prices with insurance companies. They can also make changes to your plan’s “formulary” (list of covered drugs). Given these yearly changes, it is a good idea to re-evaluate your current Medicare plan each year to make sure it still meets your needs.

Why should you consider re-evaluating your current Medicare coverage?

• You can switch to better prescription drug coverage. Using Open Enrollment to switch your drug coverage—or add drug coverage for the first time—can make crucial medications that you need less expensive. It can also ensure that your drug plan still includes and covers the drugs you need.

• You can save money and keep your doctor in-network. Switching your Medicare Advantage or Part D plan can potentially save you hundreds of dollars a year—especially if your current plan’s out-of-pocket costs will increase next year.  One way to lower your medical costs is to check that your current doctors, hospital, and pharmacy are “in-network” with whatever Medicare Advantage or Part D plan you choose. If your insurance company has changed your plan’s provider or pharmacy network for next year (and your doctor or other resources will no longer be included), you can use Open Enrollment to switch to a plan that will include your current doctors, hospital and/or pharmacy in-network, thereby lowering your medical costs.

• You can find a higher quality plan. Finally, check the quality of your plan using the Medicare 5-star ratings system.Plans with a 5-star rating are considered high quality and those with fewer than 3 stars are considered poor quality. If your current plan is ranked as less than a 3, consider using Open Enrollment to switch to a higher rated plan.

(Excerpted from mymedicarematters.org, June 15, 2017.)

Find out more.

In Missouri and Illinois, Oasis offers free and unbiased assistance provided by knowledgeable, state-certified volunteer Medicare counselors. This is a good option for first-time Medicare enrollment, claims assistance and plan changes.

For information about these services, visit https://st-louis.oasisnet.org/medicare-counseling/

“I love problem solving,” says Judy Leach.

This time of year, Judy has plenty of opportunity to do just that. An Oasis State Health Insurance Assistance Program certified counselor, she is ready to help consumers understand the ins and outs of Medicare and to find the coverage that best suits their needs.

Medicare Open Enrollment for 2017 starts October 15 and ends December 7. It may be the only time that changes to coverage can be made.

Judy and other insurance counselors provide just the kind of free, friendly guidance that many older adults want as they make decisions.

“The calls we receive are about a huge range of issues,” she says. “My best moments are when I figure out a solution to a problem that has been stressing someone out for some time. Often it’s just a matter of explaining what their options are in a way that they can understand.”

During this annual enrollment period you can:

• Switch from Original Medicare to Medicare Advantage, or vice versa

• Switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another

• Enroll in a Medicare Part D plan if you did not do so when you were first eligible (a late enrollment penalty may apply)

Do you need to make a change?

• If you are already enrolled in a Medicare Part D prescription plan or a Medicare Advantage plan and you don’t want to make changes to your coverage for 2017, you don’t need to do anything during open enrollment.

• If your plan is being discontinued and isn’t eligible for renewal, you should have received a non-renewal notice from your carrier prior to open enrollment. If you don’t, it means you can keep your plan without doing anything during open enrollment.

Changes to be aware of for 2017 include:

• Medicare recipients reaching the donut hole (a coverage gap) will benefit from better prescription drug discounts. Gap prescription drug coverage starts when someone meets the initial coverage limit ($3,700 in 2017) and ends when they have spent $4,950. While in the donut hole, enrollees pay 40% of brand name drugs and 51% for generic. The Medicare Part B deductible is $400.

• Medicare Part B premiums may increase for those who didn’t see an increase in 2016. The actual 2017 Social Security COLA (cost of living) will be known mid-November. If the COLA were to be zero again, most people paying $104.90 and people new to Medicare paying $121.80 this year will be held harmless and pay those amounts again in 2017. 

• Medicare Advantage plans continue to see changes. Most people will continue to have dozens of Medicare Advantage and Part D plans available to them, but providers can change the coverage options from year-to-year, so it’s important to carefully review the information from your plan provider.

There are many ways to get individual help as you make important decisions regarding Medicare:

• For a free and confidential one-on-one appointment with an Oasis State Health Insurance Assistance Program certified counselor, call 314-362-7587 (Missouri) or 800-392-0936 (Illinois). For assistance anywhere else nationwide, visit https://www.shiptacenter.org/.  

• Visit MyMedicareMatters/Oasis a convenient and free online service made possible in partnership with the National Council on Aging (NCOA).