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Understanding Medicare's Annual Election Period

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Medicare’s annual election period — the time between Nov. 15 and Dec. 31, when all Medicare Advantage health plans are open and accepting new members — is an important opportunity, especially for those who have recently lost their job or retired and need Medicare benefits.

No matter what time of year it is, however, it’s never too early to prepare. Make sure you understand who’s eligible before starting, and be thorough when enrolling clients. But be careful — under new rules issued by the Centers for Medicare and Medicaid Services, you must wait until after Nov. 15 to hand out enrollment forms.

Who’s eligible for what?
Eligibility is an important condition for anyone who wishes to take advantage of Medicare benefits. The Medicare Health Insurance Program is meant for people age 65 or older, some disabled people under age 65, and people with end-stage renal disease.

Eligible individuals may be enrolled in Medicare Part A, Medicare Part B, or both. Medicare Part C is an advantage plan available to those with Medicare Parts A and B.

The only eligibility requirement for Part D, which covers prescription drugs, is to have Medicare coverage. This means anyone receiving Medicare benefits, whether Part A, B, or C, is eligible to apply for Medicare Part D benefits and can acquire prescription drug coverage with a Medicare-approved provider and plan.

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How you can help your clients
As an agent, there are many ways to help your clients with their Medicare decisions.
Beyond helping them understand what Part D is and providing them with supporting materials, the easiest and most important way to help your clients is by making them aware of enrollment and election periods and deadlines.

Not meeting deadlines will mean paying more money down the road. Regarding the annual election period for prescription drug coverage, agents can help their clients by being ahead of schedule. It’s also critical to make sure all paperwork is filled out and sent on time.

Although the annual election period does not end until Dec. 31, Medicare recommends that beneficiaries make their decisions earlier in the month if possible. Doing this provides more time to update the Medicare systems so that changes will be sure to go into effect at the beginning of the year.

What else should agents be doing during this period?
During the annual election period, you may want to implement this six-step plan to ensure your eligible clients are properly enrolled:

  1. Review the client’s current insurance coverage.
  2. If the client is in a group plan, the cost of Part B and the prescription plans could outweigh staying on the group plan.
  3. When deciding when a client should purchase Part B, take into account if and when they’re planning to retire. Part B’s cost is determined by a sliding scale based on salary.
  4. Remember: The cost will be different for each client, so take your time and be sure you have calculated the costs correctly.
  5. Understand the real cost of any prescriptions a client is taking. For instance, if they are taking several medications, it may be cheaper for them to stay on a group plan.
  6. Give yourself enough time to thoroughly and methodically check all of your facts and calculations.

Stephanie Cohen is CEO of the health benefit services company Golden & Cohen. She can be reached at 866-330-0195.