1. Medicare and the New Health Care Law <br />The Affordable Care Act has been designed to provide greater savings and increased quality health care. It will also provide accountability throughout the health care system so that you have greater control over your care.Guaranteed Medicare benefits won't change, whether you get them through Original Medicare or a Medicare Advantage Plan. But you will see new benefits and cost savings, and an increased focus on quality that you need to get appropriate care. During open enrollment this fall, you will continue to have a choice between Original Medicare and a Medicare Advantage plan. Medicare will continue to cover your health costs the way it always has, and there are no changes in eligibility.As of January 2011, if you reach the coverage gap (or quot;
donut holequot;
), you will receive a 50% discount for covered brand name drugs and a 7% discount for covered generic drugs. You enter the donut hole when both you and your insurance company have spent $2,840 for covered drugs. The $2,840 dollar amount does not include any premium payments, deductibles, or drugs not covered by your plan or drugs purchased from a pharmacy not in your plan's network.Beginning in January 2011, you can get free preventive care services like colorectal cancer screening and mammograms. You can also get a free annual physical to develop and update your personal prevention plan based on current health needs. This means Medicare will begin to cover two types of physical exams - one when you're new to Medicare and one each year thereafter.Your quot;
Welcome to Medicarequot;
physical exam is covered in full and is only available during the first 12 months of your Part B effective date. This exam provides a one-time review of your health, education and counseling about preventive services, and referrals for other care if needed.<br />Initial Enrollment Period (IEP)<br />This is the time to enroll in Medicare for the first time if you are turning 65. It is your birthday month (unless your birthday falls on the first of the month, then your birthday month is the previous month) plus the 3 months prior to your birthday month and the 3 months after your birthday month. <br />Look at this:<br />Your birthday is February23rd. Your Medicare effective date is February1st. You can begin enrollment on November 1st. Enrollment ends May 31st.<br />Your birthday is March 21st. Your Medicare effective date is February 1st. You can begin enrollment on November 1st. Enrollment ends May 31st.<br />Medigap Open Enrollment Period is the period of time when an insurance company cannot:<br />Ask you any health questions to determine your rate<br />refuse to sell you any Medigap policy it sells;<br />make you wait for coverage to start (pre-existing exclusion may apply)<br />Medigap Open Enrollment lasts for 6 months. It begins on the 1st day of the month in which you are both age 65 and older and enrolled in Medicare Part B. <br />ANNUAL ELECTION PERIOD<br />October 15 through December 7 each year. New coverage becomes effective and starts on January 1.<br />You can do the following:<br />Return to Original Medicare from a Medicare Advantage (MA) or Medicare Advantage with Prescription Drug (MAPD) plan.Enroll in a MA or MAPD planEnroll in a Part D Prescription Drug planChange MA or MAPD plansChange Part D Prescription Drug Plan<br />Annual Disenrollment Period (ADP)<br />January 1st thru February 14 each year. Your Original Medicare benefits will become effective the first of the month following disenrollment from your Medicare Advantage plan. Your Prescription Drug coverage will become effective the first of the month after your application has been received.<br />You can do the following:<br />Return to Original Medicare from a Medicare Advantage (MA) or Medicare Advantage with Prescription Drug (MAPD) plan.Enroll in a Part D Prescription Drug plan if disenrolling from a MA or MAPD planApply for a Medigap (Medicare Supplement) policy (medical underwriting may be required).<br />Special Election Period (SEP) January 1st- December 31st<br />You can enroll or change plans for these reasons: <br />You are losing Employer or Union Group Health Coverage.You leave an MA plan or drop a Medigap policy because the company hasn't followed the rules or it misled you.You are in a MA plan that is leaving Medicare.Your Medigap insurance company goes bankrupt and you lose your coverage.You are in a MA plan and you move out of the plan's service area.You have both Medicare and Medicaid.You have a Medicare Select Medigap plan and move out of the plan's service area.You are in a Medicare Savings Plan (the state pays your Part B premium).You enrolled in a MA or PACE plan when you were first eligible for Part A and want to return to Original Medicare within the first year.You live in a Long Term Care Facility (e.g., a nursing home or rehabilitation hospital).You dropped a Medigap policy to join a MA plan or to switch to a Medicare SELECT plan and want to return to Original Medicare within the first year.You are receiving Extra Help paying for Medicare prescription drug coverage.You recently returned to the U.S. after living permanently outside of the U.S.You belong to a pharmacy assistance program provided by your state.You have been covered by Medicare due to disability and will be turning age 65.You recently lost Medicare Part B but still have Part A.<br />The Social Security office will help enroll you into Medicare parts A & B or go to www.Medicare.gov <br />Click on www.SaveOnMyInsurance for help enrolling you on the right plan once you receive your<br />Part A & B effective dates. Callers dial 888-807-2911.<br />