Anyone who is already on Medicare and wants to join or change a Medicare Advantage plan, or a Part D plan, must do so by this Friday, December 7th.

If you are happy with your current Medicare coverage, you don’t have to do anything. Your Medicare Advantage plan, or your Part D plan will roll over for 2013.

If you have some issues with your Medicare Advantage plan or Part D plan, you need to act quickly because the deadline for for most people to make a change is this Friday, December 7th.

Who is not affected by the Open Enrollment deadline?

If you have a Medicare supplement and the premium has gone up more than 20%, you might consider changing to another company – and the December 7th deadline does not apply to you. You can change your Medicare supplement at any time during the year (if you are healthy or in a guaranteed issue period).

If you are turning 65 in December or January (or later) the December 7th deadline does not apply to you.

If you have employer retiree coverage you are thinking about dropping (if you can), the December 7th deadline does not apply to you.

If you have recently moved to Arizona, or a new state, the deadline does not apply to you.

If you get help with your Part B premium or your drug costs, you can change your Medicare Advantage plan or your Part D plan any time during the year.

If you have Medicare AND Medicaid (AHCCCS in Arizona), you can change your Medicare Advantage plan any time during the year.

Making changes? Doctors and Drugs need to be checked.

Don’t wait until the last day of Open Enrollment (Friday, December 7th) to make a change. You can’t just pick another Advantage plan or Part D plan. You must be sure your doctors are in-network if you are considering a Medicare Advantage plan. And you must make sure your drugs are covered and what your cost will be.

If you make the wrong choice because you did not do your research (or have an insurance agent do this for you), you will be stuck in that plan for all of 2013.

I have met two women in the last two months who told me they are over 65 and collecting Social Security – but they are not enrolled in Medicare Part B because they can’t afford it. Can’t afford it???

I told them both that, without Part B, they don’t have health insurance – and if they get sick, or fall and break a hip, they will end up with very large medical bills.

The premium for Part B of Medicare is $99.90 per month. Part B covers just about every medical service except for hospitalization, skilled nursing facilities, home health care, and hospice, which come under Part A. Part A has no monthly premium because it is paid for by people who are currently paying Medicare taxes taken out of their paychecks.  Everybody gets Part A at 65, so these ladies have Part A coverage but not Part B.

Part B pays 80% of doctor bills, lab tests, emergency room charges, ambulance charges, chemo and radiation therapy, and many many more medical services. If a person doesn’t have Part B, they don’t have health insurance. And a person who doesn’t have Part B is crazy.

Help is available to pay for Part B.

I asked each of these women what their monthly Social Security check is. Both told me they get less than $1,256 per month. Because their income is below this amount, I told them they qualify to get their Part B paid by the state of Arizona. The state administers the Medicare Savings Program, though the money actually comes from the federal government – thank goodness.

25% of low income seniors and disabled Medicare beneficiaries do not know they can get help with their Medicare premium.

I was telling this story to another insurance broker, and she told me of a couple in their 80’s she met in Douglas. Between the husband and wife, they are living on $800 per month in Social Security benefits – and the husband has $99.90 taken out of his Social Security check each month!!

The broker helped this couple fill out the form for the Medicare Savings Program and will send it in to AHCCCS (Arizona Health Care Cost Containment System). It can take up to 45 days for the application to get processed.

For more information on income levels that qualify people for help with Medicare and Part D costs, see my recent post, Getting Help with Medicare and drug costs.

I’m in Connecticut visiting friends and family and enjoying the cool rain. A friend who is on Medicare was bemoaning her high drug costs and going into the donut hole, so I did a little research to see if she could qualify for help from the state of Connecticut. I was shocked by what I found.

While most states use standard income levels (up to 135% of the federal poverty level) to determine if a person should get help with their Medicare costs, Connecticut will help people who have nearly twice the standard limit.

Income of $1,246 per month for an individual and $1,675 for a couple is generally the cut-off for getting your state to pay your Part B premium ($96 – $115.40 per month). The income limit in Connecticut is $2,091 for an individual and $2,816 for a couple. And Connecticut does not consider assets a person has such as bank accounts, investments, or retirement accounts. They only look at  a person’s income, so people who live on their Social Security check would likely qualify for help from the state of Connecticut.

If my friend qualifies for help from the state of Connecticut, the state will inform Social Security that she also qualifies for help with her Part D costs.  When this goes into her Medicare record, she will pay $6.30 for her brand drugs and $2.50 for generics, which is the help she really needs.  And she will have no donut hole in her Part D coverage, saving her thousands of dollars each year.

Now, before you decide to move to Connecticut, I must warn you that my home state is an expensive place to live.  My friend had mail from a Medicare supplement company and I was shocked to see that the cost of a Medigap Plan F  is $220 per month for a person turning 65 in Connecticut. That is $100 more than the cost in Arizona for the same coverage with the same company.

Medicare Advantage plans are also more expensive in Connecticut. My friend is enrolled in an Advantage plan for which she pays $110 per month – though it offers much better coverage than $0 premium plans in Arizona.  And we won’t even talk about property taxes, which are three to five times higher than in Arizona.

Maybe, when I’m 65, I’ll buy a Medicare supplement in Arizona and spend my summers in Connecticut – though I can probably only afford a single-wide trailer at Connecticut prices.

For more info on getting help with Medicare and Part D costs, check out a previous post: Help with Medicare Costs

Folks in Connecticut should contact an Agency on Aging for more info and an application.  Here is a link to a web site that provides phone numbers for offices across the state.  http://www.ctagenciesonaging.org/pages/home.php

I came across a website for Connecticut elder services and found an application there – but the application was four pages and asked for lots of info. Turns out that is an old, out-of-date application.  The new application is just two pages.  I used the link above and talked to a very nice lady in Norwich who sent my friend the correct application for the Medicare Savings Program.