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Open Enrollment Is Oct 15 – Dec 7: Review Your Medicare Options For 2013

October 12, 2011

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Provided By: California Health Advocates

Open Enrollment, also known as the Annual Election Period (AEP), is the period each year during which you may change your Medicare Advantage plan and/or Part D coverage, and/or return to Original Medicare. The AEP is October 15 – December 7. Any plan changes you make during the AEP are effective January 1.

Each year, Medicare health plans and Part D prescription drug plans can change their premiums, deductibles, cost-sharing and some benefits, or discontinue their coverage altogether. You need to be aware of how your plan may change, and prepare accordingly.

  • Review your plan’s changes for 2013. If you’re in a Medicare Advantage and/or Part D plan, your plan should have mailed you an Annual Notice of Change by September 30, explaining its changes for 2013. For example, the Annual Notice of Change would include information such as your premium and copayment, if your plan’s provider network will change, and/or a list of drugs (called a formulary) that will be covered. Even if you like your current plan, review your plan’s changes for 2013 and compare other options to determine which 2013 plans have the coverage you need.
  • Look for other options. If your health plan or drug plan is terminating its coverage, you should receive a notice by October 2 informing you of your rights and options for other coverage. See When Medicare Advantage Plans Terminate Coverage.
  • Be on the alert. Medicare health plans and prescription drug plans can start marketing their 2013 plans as of October 1, 2012. Agents and brokers selling these plan must follow strict guidelines when marketing to you — report any suspected marketing fraud or abuse to the Senior Medicare Patrol at 1-855-613-7080.

What can I do during Open Enrollment?

You can make changes involving your Medicare Advantage or Part D plan. Medicare Advantage plans must include hospital and medical benefits. Some Medicare Advantage plans also cover prescriptions drugs. Stand-alone Part D plans cover only prescription drugs. Thus you can get prescription drug coverage through a Medicare Advantage plan or a stand-alone Part D plan.

During the AEP, you can enroll in a Medicare Advantage or a stand-alone Part D plan if you do not have one. If you do have one of these plans, you can change to a different stand-alone Part D plan or Medicare Advantage plan. If you’re in a Medicare Advantage plan, you can return to Original Medicare and join a stand-alone Part D plan for prescription drug coverage.

What are my coverage options?

  • Your local Health Insurance Counseling & Advocacy Program (HICAP) has county-specific information on the Medicare advantage and Part D plans available in your area, as well as info on Medicare supplement plans known as Medigap.
  • Use the Plan Finder and Formulary Finder on to find Medicare Advantage and Part D plans in your area and to see what Part D plans cover the drugs you use.
  • Read the official U.S. government Medicare handbook: Medicare & You 2013 (PDF). Hard copies were mailed to beneficiaries between September 16-30, and it is also available online. (See the “Go Paperless” option on for more info.)

I receive the Part D low-income subsidy (Extra Help) and currently don’t pay any premium or deductible. Can I stay in my same plan or do I need to switch plans to continue with no premium or deductible?

This depends on what plan you are in. In 2013, the Welcare Classic plan has a higher premium and will no longer be a benchmark plan. Benchmark plans are plans whose premiums are at or below the weighted average of premiums in California ($29.88 for 2013). If you are in Welcare Classic, you will need to choose a Part D plan that has a premium amount at or below $28.99. If you do not choose another plan by December 7, Medicare will reassign you to a benchmark plan so that there is no gap in your prescription drug coverage.

Health Net Orange Option 1 and CVS Caremark Value, 2 of the benchmark plans in 2012, are merging into the SilverScript Basic prescription drug plan in 2013. SilverScript Basic will be 1 of the 6 benchmark plans offered in 2013. If you are currently in the Health Net or CVS Caremark plan, you will automatically be merged into the SilverScript Basic plan starting January 1, 2013 if you do nothing. You can change to another Part D or MA plan during the AEP.

(Note that Community CCRx Basic prescription drug plan is also merging into the SilverScript Basic plan. This Part D plan was not a benchmark plan in 2012; enrollees in Community CCRx Basic will also be automatically merged into the SilverScript Basic plan as of January 1 if they do nothing.)

For 2013, California has 6 benchmark plans:

  1. Aetna CVS/pharmacy Prescription Drug Plan
  2. EnvisionRxPlus Silver
  3. Humana Walmart-Preferred Rx
  4. SilverScript Basic
  5. SmartD Rx Saver
  6. AARP MedicareRx Saver Plus

If you continue to be eligible for Part D Extra Help, by joining a benchmark plan you will not have to pay a premium or deductible for 2013. You are still responsible for your copays which will be up to $1.15 or $3.50 for generic drugs or up to $2.65 or $6.60 for brand name drugs depending on your income and assets.

What if I miss the AEP and still want to make a change? Are there other times during the year I can change my health plan and/or Part D coverage?

The AEP is the main time most Medicare beneficiaries can change plans. However, some Medicare beneficiaries may change plans at other times:

Medicare Advantage Disenrollment Period (MADP)

If you’re in a Medicare Advantage plan with or without Part D coverage, you can disenroll from your plan and return to Original Medicare anytime between January 1 – February 14. You are also given a Special Election Period (SEP) to enroll in a Part D plan during this time. But you may not enroll in a Medicare Advantage plan at this time.

Your MA plan disenrollment becomes effective the first day of the following month. For example, if you disenroll from your MA plan in January, your change becomes effective February 1. If you diseroll in February, your change becomes effective March 1.

We also encourage you to enroll in a Part D plan as close to the time of your MA plan disenrollment as possible in order to avoid any gap in drug coverage. For example, if you disenroll from your MA plan on January 28 and enroll in a Part D plan on February 1, you would return to Original Medicare on February 1, but wouldn’t have drug coverage until March 1.

Plan Non-Renewal Special Election Period

If your MA or Part D plan is not renewing next year, you should have received a notice from your plan by October 2 telling you of this change and your rights and options for other health coverage.

One of your rights is that you have a Special Election Period (SEP) to join a new plan. The SEP is from December 8 to February 28 the following year. Your new coverage will become effective the first day of the following month.

Ongoing Special Election Period Right for Certain People with Low-Incomes

People who receive the Part D Extra Help (which includes people in a Medicare Savings Program) can change their Medicare Advantage and/or Part D coverage on a monthly basis.

5 Star Medicare Advantage or Part D Plan Special Election Period

If you live in an area with a Medicare Advantage and/or Part D plan(s) that has an overall plan performance rating of 5 stars, and you’re otherwise eligible to enroll in the plan, you have a Special Election Period (SEP) to join that plan. Medicare releases plan performance ratings each fall and the ratings apply for the following calendar year. Your SEP is from December 8 through November 30. Your new coverage will become effective the first day of the following month. You can use this SEP to enroll in a 5-star plan only once during the SEP.

Other Special Election Periods (SEPs)

There are certain events/situations that trigger your rights to other SEPs where you can enroll in, switch, or disenroll from a Part D or Medicare Advantage plan. Some of these events include if you move out of your plan’s service area; your plan violates its contract with Medicare (including marketing misconduct); you are in a plan with a low-rating (less than 3 stars); or you move in or out of a nursing facility. See our list of events triggering an SEP for more information.

Can I switch plans more than once during the AEP?

Yes, you can. Your final choice will be the last one received by December 7. Your new coverage becomes effective on January 1.


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