Medicare Open Enrollment

Additional Counties in CA Added to the Special Election Period for Medicare!

Additional counties in California will have a Special Election Period (SEP) available for Medicare beneficiaries affected by the California wildfires.  *FEMA declared an emergency or major disaster for the following counties:

New counties added as of Dec. 8, 2017*:

-Los Angeles
-Riverside
-San Diego
-Santa Barbara
-Ventura

Counties previously issued with an SEP:

-Butte
-Lake
-Mendocino
-Napa
-Nevada
-Orange
-Solano
-Sonoma
-Yuba

Special Election Period Overview

The wildfires in California have caused and continue to cause disruption. The Centers for Medicare & Medicaid Services (CMS) has extended a SEP to Medicare beneficiaries affected by the fires. The SEP runs from the start of the incident through Dec. 31, 2017.

Who is eligible?

Any beneficiary who resides in, or resided in, an area for which the Federal Emergency Management Agency (FEMA) declared an emergency or major disaster (see www.fema.gov/disasters) is eligible for the SEP, if the beneficiary was unable to enroll in a plan during another qualifying election period. In addition, beneficiaries who do not live in the impacted areas but receive assistance from someone living in one of the affected areas also qualify for this SEP.

What does this mean for Medicare beneficiaries?

Eligible beneficiaries who were unable to make a plan selection during the Annual Enrollment Period (AEP) have until Dec. 31, 2017, to enroll in a 2018 plan. Eligible beneficiaries who wish to change their health and/or prescription drug plan, but were unable to do so during the Annual Enrollment Period (Oct. 15, 2017-Dec. 7, 2017), will now have until Dec. 31, 2017, to enroll in a 2018 plan. Enrollments taken between Dec. 8 and Dec. 31, 2017, are effective Jan. 1, 2018.
Eligible beneficiaries who were eligible for a different SEP, or aged into Medicare, but were unable to enroll during the allotted time period, will have their election period extended. Eligible beneficiaries who had/have a qualifying election period (e.g., aged into Medicare, are aging into Medicare or are qualified for a different SEP) but were unable to enroll in a plan during the allotted time, have until Dec. 31, 2017, to enroll. Enrollments received are effective the first day of the following month. For example, if a beneficiary aged into Medicare and had until Aug. 31, 2017, to enroll but was unable to complete the enrollment process, the beneficiary can enroll now. If the beneficiary enrolls Oct. 28, 2017, the beneficiary’s plan will be effective Nov. 1, 2017.

What is needed as proof the beneficiary was affected by an affected area?

If the beneficiary is unable to provide proof that they reside in an affected area, the beneficiary just needs to verbally attest that they lived/live in an area impacted by the wildfires.

MEDICARE ISSUES A SPECIAL ELECTION PERIOD FOR THOSE AFFECTED BY CA WILDFIRES

The Centers for Medicare & Medicaid Services (CMS) has extended a Special Election Period (SEP) to Medicare beneficiaries affected by the wildfires in CA. The SEP runs till Dec. 31, 2017.

Who is eligible?

Any beneficiary who resides in, or resided in, an area for which the Federal Emergency Management Agency (FEMA) has declared an emergency or major disaster (see www.fema.gov/disasters or the list below*) is eligible for the SEP, if the beneficiary was unable to enroll in a plan during another qualifying election period. In addition, beneficiaries who do not live in the impacted areas but receive assistance from someone living in one of the affected areas also qualify for this SEP.

*FEMA declared an emergency or major disaster for the following counties:

  • Butte
  • Lake
  • Mendocino
  • Napa
  • Nevada
  • Orange
  • Solano
  • Sonoma
  • Yuba

What does this mean for beneficiaries?

Normally, Medicare beneficiaries only have till December 7th to make changes to their Part C (Medicare Advantage) or Part D (Drug) plans.  Eligible beneficiaries who are unable to make a plan selection during the Annual Enrollment Period (AEP) have until Dec. 31, 2017, to enroll in a 2018 Plan.  Enrollments taken between Dec. 8th and Dec. 31st 2017, will be effective Jan. 1st 2018.

Verifications

  • Individuals must show proof that the beneficiary resided in an affected area (e.g., driver’s license or utility bill reflecting the beneficiary’s address).
  • If the beneficiary is unable to provide proof, ask the beneficiary if they attest that they lived/live in an area impacted by the wildfires.
  • Once eligibility is verified, the application can proceed.
  • Only paper applications can be used. Use the SEP election type code on the application, and write in ‘Weather Related Emergency’ or ‘Fire’.

If you are not sure if you fall under these guidelines, give us a call and we can check for you – 323.455.4961.

Medicare Open Enrollment October 15th – December 7th

Today begins Medicare Open Enrollment – Oct 15th – Dec 7th. This is the time to change Part C (Medicare Advantage Plans) and Part D (Part D Plans). All plans seem to change something, especially the drug formulary. Look at your ANOC (Annual Notice of Change) booklet that you recently received (or call your Plan if you haven’t received it yet).  The first few pages will tell you what is changing in your Plan for the next year. There are also new Plans out for 2018 and you need to research to see if there is another Plan that may offer you better benefits.   Many Medicare Advantage Plans offer extra benefits like chiropractic, acupuncture, vision, hearing, dental or gym memberships.  If you feel your Plan is good for you next year, there is nothing to do.  It will simply roll over.

If you have a loved one that is on Medicare, please help them.  Many times, they stay on the same Plan because they just don’t know how to research.  You can make a huge difference in their lives by getting them to call us!

Be aware of the Star Ratings of the Plans also.  Medicare gives an overall rating of the Plan’s quality and performance for the types of services each plan offers.  For plans covering health services, this is an overall rating for the quality of many medical/health care services that fall into 4 and 5 different categories.  From my experience, there is a reason a Plan gets a low rating so BEWARE!

This is also the time for those that are uninsurable to possibly obtain ‘guaranteed issue‘ into a MediGap supplement plan. If ANY benefit in your Medicare Advantage Plan increased by 15% or was eliminated, you can go back to original Medicare (Part A & B) and obtain a stand alone Part D Plan (for drugs).   Being on this option (with a MediGap plan) gives you the choice to see any Provider that accepts Medicare, no referral needed.  It comes in handy if you want to go to a skilled nursing facility of your choice or see a Provider out of town.  

You can do your own research by going to Medicare.gov or reach out to an independent insurance agent such as ourselves.  We conduct a thorough search for you and will let you know if your Plan is still the better Plan for you next year.  And there is no extra charge for our services.  How do we get paid?  If another Plan is better and we’re able to place the application for you, we receive a commission from the insurance company.  Make sure the person you are dealing with is REALLY independent and represents MANY companies.  We have come across many agents that claim they are independent and they are however, they are only Medicare certified with one or two companies.  At Hoffman Insurance, we are contracted with over 40 companies and Medicare certified with 13 carriers.  You’re best interest is our interest, whether we get compensated or not.  Reach out to us early because it gets quite busy during the last week of Open Enrollment!