Medicare Open Enrollment for 2016 coverage begins October 15, 2015 to December 7 2015

During this annual enrollment period (AEP)  you can make changes to various aspects of your coverage.

Original Medicare

Medicare Advantage

Part A and B

Part D

  • You can switch from Original Medicare to Medicare Advantage, or vice versa.
  • You can also switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another.
  • And if you didn’t enroll in a Medicare Part D plan when you were first eligible, you can do so during the general open enrollment, although a late enrollment penalty may apply.

If you want to enroll in a Medicare Advantage plan, you must meet some basic criteria.

Between January 1 and February 14 each year, if you are enrolled in a Medicare Advantage plan, you can leave your plan and return to original Medicare. You cannot switch to another Advantage plan unless you have a circumstance that affords you a Special Enrollment Period.

After you leave your plan, you will have until February 14 to enroll in a Part D plan that will begin the first day of the following month that you enroll.

Enrolling in Original Medicare

If you didn’t sign up for Medicare A and B when you were first eligible, you have a chance to do so each year from January 1 to March 31, with coverage effective July 1.  You may be subject to a late enrollment penalty however.  For Medicare Part B, the penalty is an additional 10 percent of the premium for each 12 month period that you were eligible but not enrolled.

2016 Medicare coverage changes

Changes to be aware of for 2016 include:

  • Medicare recipients reaching the donut hole will benefit from better prescription drug discounts. The gap in prescription drug coverage (the donut hole) starts when someone reaches the initial coverage limit ($2,960 in 2015), and ends when they have spent $4,700. (In 2015, both of these thresholds will likely change slightly for 2016.)Prior to 2011, Medicare Part D enrollees paid the full cost of their medications while in the donut hole. But the ACA has been steadily closing the donut hole, and it will be fully closed by 2020. At that point, enrollees will pay just 25 percent of the cost of their drugs all the way up to the catastrophic coverage threshold. For 2016, while in the donut hole, enrollees will pay 45 percent of the cost of brand name drugs (unchanged from 2015) and 58 percent of the cost of generic drugs (down from 65 percent in 2015).

  • Cost for Medicare Part B premiums likely to increase for higher income beneficiaries.  The President’s 2016 budget calls for higher Medicare Part B premiums for higher-income beneficiaries.  Most enrollees pay the standard premium ($104.90 in 2015), but those with incomes above $85,000 ($170,000 for a married couple) pay more.  The additional percentage they pay is expected to increase in 2016.
  • Medicare Advantage plans continue to see changes. While healthcare reform is slowly reducing rebates paid to Medicare Advantage plans, these plans continue to be popular. 30 percent of Medicare recipients are enrolled in a Medicare Advantage plan in 2015 – a significant increase from the enrollment total in 2009 when the ACA was signed into law. Most people will continue to have dozens of Medicare Advantage plans as well as Part D plans available to them. However, these providers can change the coverage options they offer from year to year so it’s important to stay up-to-date.

Most Medicare beneficiaries should receive their Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from their existing Medicare Advantage and Medicare Part D plan providers by Sept. 30. CMS is expected to make information available to the public on Medicare.gov in October. The Medicare website is also a tremendous asset for individuals with questions about Medicare rules, timelines, Medicare Part D, etc.

It’s important to carefully review the information sent to you by your plan provider, since this will cover any possible changes. For example, increasing co-pays, changes to drug formularies or changes to treatment coverage.  Then once open enrollment begins in mid-October, you’ll be ready to make plan changes that reflect your current health plan needs.

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