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Helpful Internet Links
If you’re online, use these links to find helpful
information at the following locations.
Contact Extend Health
www.extendhealth.com
Learn about Medicare
www.extendhealth.com/medicare/understanding-medicare
Search for Medicare Insurance Options
www.extendhealth.com/medicare/quote/search
How to Contact Us:
We want to hear from you!
www.extendhealth.com/help/speak-to-an-expert
www.extendconnections.com
To speak to a licensed benefit advisor, call:
www.facebook.com/extendhealth
1-866-343-5757
(TTY: 711)
8 a.m. – 9 p.m. Eastern Time
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www.youtube.com/extendhealth
ExperienceChoice: Extend Health Newsletter for Medicare Retirees
To receive your copies of this newsletter by email rather than post, please send an email to
[email protected] with “Subscribe to ExperienceChoice” as the subject.
Medicare has neither reviewed, nor endorsed, this information.
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ExperienceChoice
Extend Health Newsletter for Medicare Retirees
In This Issue:
Information You Can Use
• Enrollment Period Calendar
Medicare’s annual Open Enrollment Period is
coming soon. This yearly event allows people
with Medicare Part D prescription drug plans or
Medicare Advantage plans to drop their current
coverage and enroll in new plans if they choose.
• Information You Can Use
• The Medicare Open Enrollment
Period: What You Need To Know
• A Guide to Health Care Reform
and Medicare
Enrollment Period Calendar:
Open Enrollment Period
October 15 – December 7, 2013
While no action is required, you
can enroll in, or change existing,
Medicare Advantage and prescription
drug coverage (coverage begins
January 1, 2014).
General Enrollment Period
January 1 – March 31, 2014
You can sign up for Part A and/or
Part B if you didn’t when you were
first eligible.
Medicare Advantage Disenrollment
Period
January 1 – February 14, 2014
You can leave Medicare Advantage
and switch to Original Medicare.
If you switch to Original Medicare
during this period, you have until
February 14 to also join a Medicare
prescription drug plan.
Medigap
There is no special enrollment
period for Medigap. Changes to your
Medigap coverage may be subject to
underwriting—meaning you can be
rejected based on your pre-existing
medical conditions.
You are receiving this newsletter because our
records show that you have enrolled in a plan
with the help of Extend Health, a Towers Watson
company. The newsletter is sent out twice yearly
to make sure you are up to date on the latest
Medicare information.
People often ask us if they need to do anything
to make sure they continue to have Medicare
health insurance in the next year. The answer
is no, you do not have to do anything. If you are
happy with the coverage you have now, do nothing.
Your enrollment in your plan or plans continues
automatically unless you decide to change. We hope
the information in this newsletter is helpful as you
think about your health insurance needs for 2014.
The Medicare Open Enrollment
Period: What You Need To Know
The Medicare Open Enrollment Period (also
called Annual Enrollment Period) happens every
year between October 15 and December 7.
During the Open Enrollment Period (OEP), you
have a chance to make changes to your Medicare
Advantage and Medicare prescription drug
coverage for the following year.
That doesn’t mean you have to make changes.
If you wish to keep your current plans,
all you need to do is continue to pay your
premiums. There are only a few reasons that you
might want to make a change during this period:
Medication-related changes
Every prescription drug plan is based on a list of
drugs, called a formulary. In most plans, drugs are
divided into tiers or levels, with different co-pays
depending on the tier. Some plans have more tiers,
and some plans have fewer.
So far so good. But let’s say you’ve chosen your
current plan because a medication you depend on
is in a lower tier and the co-pay is affordable. Your
insurance company may choose to move your drug
into a different tier at the beginning of the next
year. Under certain circumstances such as the new
availability of a generic version, the insurer may be
allowed to move it during the plan year.
ExperienceChoice
Extend Health Newsletter for Medicare Retirees
After October 15, 2013, you
can use the Prescription
Profiler tool on the Extend
Health web site to help you
review and evaluate 2014
prescription drug plans.
If this happens to a drug you take, you may
find that your cost has increased. If the
increase is large or unaffordable, it’s a good
idea to research plans during the OEP to see
if another plan will reduce your out-of-pocket
costs. The same is true if you’ve started taking
an expensive medication during the year; you
may want to review plans to see if you can find
one that covers more of the cost.
Other changes
Other events that might make it a good idea to go
shopping for new insurance include:
• Change of address: If you have moved
during the year to a new zip code, but
haven’t changed your insurance company, it’s
probably wise to investigate plans that are
local to your new area.
• Premium increases: Premiums go up each
year, and sometimes more than once a year,
due to the ever-growing cost of medical
services. The key to knowing whether it’s
time to make a change is how your premium
compares to similar plans in your area.
If your premium is still competitive with
the premiums of comparable plans, then it
probably doesn’t make sense to change.
Watch your mailbox
Around the end of September your Part D drug
plan provider, or your Medicare Advantage
plan provider, will send you an Annual Notice
of Change letter. Pay special attention to this
letter. It will include any changes to your plan
premium, co-pays or other fees, and to the plan’s
formulary. You can use the information in this
letter to decide if you need to look for another
plan during the OEP.
Sometimes it’s better to keep what you
have
It’s never a bad idea to review your coverage
and determine if you need to change what you
have, but often the best decision is to stay with
your current plan or plans.
This is especially true if you have Medicare
Supplemental (Medigap) insurance.
Unlike Medicare Advantage, Medigap is
only “guaranteed issue” under certain
circumstances—such as when you first become
eligible for Medicare, if you’ve moved to a new
area, or if your insurance company terminated
your plan. In most other cases, if you want to
change to another Medigap plan you’ll have
to go through underwriting and you could be
denied coverage. It’s not impossible to switch,
but there are no guarantees you’ll be successful.
Staying with your plan avoids possible
consequences such as having to change doctors
or pharmacies, which can be inconvenient or
lead to lapses in your care.
There are ways to lower your medication costs
that don’t require a plan change. For example,
you can consider switching to a generic version
of your drug if one is available. Coincidentally,
one of the “triggers” for a brand-name drug
being moved to a higher-cost tier is when a
generic version becomes available.
Buying through mail order or your prescription
drug plan’s preferred pharmacies can also save
you money. It may surprise you to know that
different pharmacies charge different amounts
for the same medication—so it makes sense to
buy from the one that offers you the lowest price.
The bottom line
Our advice is to be a smart shopper. Evaluate
changes to your plans against what is available
in the market. Be aware that plan premiums
do go up almost every year—an increase isn’t
always a sign that you should change your
insurance coverage. But if you experience
changes in health status, in the medications
you take (or their cost to you), or if you move
to a new place, it’s well worth it to review your
options by visiting Extend Health’s web site
during the OEP.
ExperienceChoice
Extend Health Newsletter for Medicare Retirees
A Guide to Health Care Reform and Medicare
Have you been wondering how the Affordable Care Act (ACA) affects Medicare? Read on
for a quick guide to the changes health care reform brought to Medicare—and how it will
affect your children and grandchildren, too.
Changes to Medicare under the ACA
Changes to look forward to
Coverage gap or “donut hole”
Changes that don’t involve Medicare are worth
noting if you have family members or friends
who have had a hard time getting or affording
health coverage.
The biggest change to Medicare under the
ACA is that the coverage gap or “donut hole”
in prescription drug coverage will be closed by
2020. Seniors who fall into the coverage gap
this year will get a 52.5% discount on brand
name drugs and a 28% discount on generic
drugs until they reach their out-of-pocket
limit. As the donut hole continues to close, the
savings will increase.
Free preventative care
Preventative services are now covered without
co-payments. That means that when you go to
see your doctor for this care or to get these tests
done, you won’t have to pay anything out-ofpocket. Many services including preventive care
and screening tests are now covered in this way.
All insurance is now “guaranteed issue” – Just
like Medicare, after January 1, 2014, no one
can be turned down for insurance due to a preexisting condition.
Parents’ insurance covers children up to age 26
– Children up to the age of 26 can be included
on their parents health plans. Estimates are
that over three million young adults who
otherwise would not have had coverage have
been included in their parents’ plans so far.
Limits on what insurers can spend on overhead
Insurers are now required to spend at least
80-85% of premium dollars on medical care,
keeping the amount they spend on other costs
to no more than 15-20%. The requirement
applies to Medicare Advantage and Medicare
Part D plans, as well as to health plans for
people under the age of 65. If insurance
companies don’t meet this requirement, they
are required to refund the overcharges.
Things you don’t have to worry about
You don’t need more than your Medicare
coverage – If you already have Medicare health
insurance that you are happy with, there’s
nothing more you need to do or buy to comply
with the ACA.
You can keep seeing your current doctor – The
ACA does not force people to find a new doctor,
specialist, hospital, or pharmacy.
It won’t make Medicare cost more – The vast
majority of seniors will see their Medicare drug
costs go down due to the donut hole closing.
Generally, premium increases for your medical
plan are due to the rise in health care costs—
not the result of health care reform.
Exchanges make health insurance available
and affordable – People of all ages will have
access to their own health coverage through
each state’s health insurance exchange. And
people whose families earn below a certain
amount will get subsidies to help pay for their
premiums.
If any of your loved ones have gone without care
or been forced to seek care in the emergency
department only as a last resort, they will soon
have access to care that’s comparable to what
you can get on Medicare. And that’s something
we can all look forward
to.
We are changing our name!
Extend Health will become Towers Watson
January 2014