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Sunday, February 20, 2011

What Seniors Ought to Know About Medicare Benefits in 2011 - Part 2

Medicare continues to offer choices for seniors beyond age 65 throughout the year. I covered the benefits to seniors in Part 1 who are aging in. Here, in Part 2, I will focus on the benefits available to those over 65. But first, a little history. As of now you are in the "lock in" period which essentially means that your Medicare choices are extremely limited. That is, this is the time in which most Medicare beneficiaries are unable to change their underlying Medicare coverage.

In past years an Annual Enrollment period ran from November 15 to December 31, then an Open Enrollment Period (OEP) ran from January 1 to March 31. Now with the Patient Protection and Affordable Care Act (PPACA) in place, OEP has been replaced by the Medicare Advantage Disenrollment Period (MADP). During the MADP, which ended Feb 14th, you can only leave Medicare Advantage and return to original Medicare and a Prescription Drug Plan. The exceptions are those who qualify for a Special Election Period (SEP), and those who have Special Needs. Generally, a change in a Medicare beneficiary status with their current coverage would trigger an SEP. An example would be individuals who loses their employer group or retiree coverage or the Medicare Advantage enrollees who move out of their service area and find themselves dropped from their plan.

Beyond these two examples, there are two SEPs that are based on a senior's financial status: those who are receiving the Medicare Low Income Subsidy can enroll in a Medicare Advantage Plan the year-round, and those who are enrolled in their State Pharmaceutical Assistance Plan (SPAP) are eligible for one election into a Medicare Advantage Plan, which includes the Medicare Prescription Drug Benefit. The plan for those with Special Needs is a type of Medicare Advantage Plan that is available specifically to that special population: the dual eligible, chronic illness, and institutional. The dual eligible are those who qualify for both Medicare and Medicaid. Those who have a chronic illness are those who a physician has certified as being treated for a qualified medical condition that is specifically designated in the plan. And, institutional refers to those who are confined to a long-term care facility.

Finally, if you're interested in a Medicare Supplement Plan, you can enroll in it year around if you have Original Medicare A or B. Also, you can change your Medicare supplement coverage any time. It certainly may be a good idea to have a qualified agent to evaluate your coverage to see if you can save some money on your policy.

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