Medicare Part D countdown has begun


My plan for today’s column had been to write about bed rails – Yes, “bed rails.”

Everybody who works in a hospital or a skilled nursing facility or some such is thinking, “Right, bed rails. I get it.” You’re thinking, “Bed rails?!” Oh, yes I can … and in the future I still may, just to prove to you that I can do it, but not today; no, today is going to be about Medicare (again) because, as per the bumper sticker that would probably make me rich, Medicare…happens.

Here’s what’s happened this time: As just about everybody who is even distantly concerned with Medicare well knows, we are right in the middle of what most of us call “open enrollment” for Part D and Advantage Plans, so what happened? Well, some Part D, and Advantage Plans decided to leave certain areas, so won’t be around next year, and because they are private plans, they can do that.

Oops! OUCH!

So, that’s what we’re about today, and what I’m going to tell you here is Federal stuff – National stuff – So, if this happened to Cousin Clark in Kansas City this will apply to him too, OK? OK. So, if you’re Part D or Advantage Plan (most likely, the latter) is leaving your county in 2013, here’s what you’re looking at:

In addition to the “open enrollment period” that we’re smack in the middle of, you will also have a “special” enrollment period that will run from Dec. 8, 2012, through Feb. 28, 2013, to switch to a new Advantage or Part D plan; remember, this is ONLY if you’re Plan is leaving. Not liking your current one, or finding a better deal or just being contrary doesn’t count – your plan has to be leaving; if they are, you’ve got until 2/28/13. Your new Plan’s effective date will depend upon when you actually enroll.

If the Plan that is rudely abandoning you is an Advantage Plan, you could decide to join a Medicare Supplement plan (aka MediGap, MedSupp). If you do that within 63 days after your current Advantage Plan terminates (probably Dec. 31, 2012), the MediGap plan has to accept you WITHOUT A HEALTH SCREENING, which is also known as “guaranteed issue.”

It’s OK to go back and read that again, because it took me several tries to write it. OK? That could be a very big deal for some folks.

The “bad news” is that if you’re under 65 on disability, you’re still limited to the MediGaps that will “accept” you. I’m sorry. Really. I know this is a HUGE blow to some of you, and I wish I had a better answer.

So, what if you’ve been lounging about in the Caribbean and don’t get around to switching to a new plan by Dec. 7? Well, if you have LIS (“low income subsidy,” “extra help” – wWe’ve talked about this before), Medicare will automatically switch you to a new “benchmark” plan that will kick in Jan. 1, UNLESS you choose a new one by Dec. 31 (go ahead, read that again – it is confusing). If you get “switched,” CMS (Centers for Medicare and Medicaid Services) will send you a blue letter (yes, BLUE) telling you what plan you’ve been switched to. But you still have until 2/28/13 to change that; besides, if you do have LIS, you can actually change anytime! Whew!

Now, if you don’t have LIS and you were carousing in the Caribbean, Medicare will return you to “original” Medicare (meaning, Part A/Part B), with no other coverage, which means no “MediGap” – But you still have until 2/28/13 to do something.

If any of this is happening to you or somebody you like, start working on this NOW! And, info on available plans for 2013 is up on www.medicare.gov now. Should you decide to move to a different Advantage Plan, be sure to check with your medical providers FIRST, to be sure that they accept that plan; otherwise…Oops!

I know. If none of that made any sense at all, just call any of the numbers at the end of this column and decent people will help you – for free – without trying to sell you anything or make you feel like an idiot, because you’re not.

No, you’re not; I know that this can all make you feel like you are, but you’re not. It is unbelievably complicated! And I wish I could tell you when it was all going to start making sense, so regular people could actually understand it, but I can’t, because I don’t know.

Nobody knows, so here’s the only thing you can do:

The best you can.

I’m serious: There’s no magic decoder ring or secret file or wonderful website or exceptional salesperson or humanistic insurance company that can make this all be fine. If anybody tells you that there is, they’re either lying to you or trying to sell you something.

What there is, is good people, who genuinely care and will try their best to help, but that’s as good as it’s going to get; in the end, it’s on you.

It’s on us.

Here’s what I can absolutely guarantee you: What will happen if you do absolutely nothing?

Nothing good.

Mark Harvey is the director of Senior Information and Assistance for Olympic Area Agency on Aging. He can be reached at harvemb@dshs.wa.gov or 532-0520 in Aberdeen, (360) 942-2177 in Raymond or (360) 642-3634. FACEBOOK: Olympic Area Agency on Aging-Information & Assistance.