Medicare Q and A
By Karen Harding
From Issue 56: Winter 2023
There are many Gardiner residents who have tons of questions related to Medicare, the government-supported health insurance for those over 65 years of age; some of these questions are addressed here:
Q. Why are there so many Medicare commercials lately? They are so confusing!
A. October 15th through December 7th is the Annual Enrollment Period (AEP) for Medicare. During this time, people who are enrolled in Medicare Advantage plans and Prescription Drug plans can change their current plans and enroll in new plans that will begin on January 1st. Companies do a lot of advertising during this time to try to get people to switch to their plans.
Q. Is this the only time I can enroll in a plan?
A. No, AEP is the time during the year when you can review your needs and make a switch if needed. There are other times during the year when you can qualify for making a change, including things like retiring, moving, going on Medicaid, and more.
Q. I’m already in a plan I’m happy with. Can’t I just stay with the same one?
A. Yes. Generally, if you don’t do anything, you will automatically be reenrolled into the same plan. You would want to verify that your medications are covered as the coverage and costs can change. If there are changes to your plan, or if the plan is ending, the company is required to notify you. You should receive an Annual Notice of Change letter to let you know what the changes will be.
Q. I got a phone call from Medicare, and they switched me to a plan that none of my local doctors participate in. What can I do?
A. First of all, Medicare will never call you to switch your plan. Unscrupulous companies may call, claiming to be from Medicare. They can be very convincing, and there are a lot of scams out there. Never give your Medicare number to someone you don’t know over the phone. If you do end up in a plan that you are not happy with, call a local agent or 1-800-MEDICARE for help switching to another plan that works for you.
Q. I get so many annoying phone calls about Medicare from people I did NOT request to contact me. How can I make them stop?
A. You can file a complaint with the Federal Communications Commission in two ways. You can call 888-225-5322 Or go to their website: https://consumercomplaints.fcc.gov/hc/en-us/requests/new?ticket_form_id=39744
Q. I heard that a bill was passed that will help me save money on prescriptions. What exactly are the changes?
A. The Inflation Reduction Act was recently passed. Among many other things, it will lower drug costs in several ways. Medicare will be able to negotiate prices for high-cost drugs for the first time ever. In 2023, Insulin will be more affordable, with a $35 per month limit for a 30-day supply of covered insulin and no deductible. Certain vaccines, such as Shingles, will be available at $0 cost. Beginning in 2025, it also creates a $2000 cap on annual out-of-pocket drug costs.
Q. That’s great, but how can I save money on my prescriptions NOW?
A. That’s where a local agent, who is licensed and trained in providing Medicare counseling, can help you. You can compile a list of your medications, and they can assess the various plans available to you and provide suggestions. You can also run your own quotes on Medicare.gov. If you are having trouble paying for prescriptions, there are Federal and State programs available that can help with the costs for eligible beneficiaries. The local Office of the Aging in Kingston can also help. Their Health Insurance Information, Counseling and Assistance Program – HIICAP– provides free, accurate, and objective information, counseling, assistance, and advocacy on Medicare.