Many of us know of the “Get out of Jail Free Card” used in the board game Monopoly. Simply put, this card can be used in the game to get you out of a bad situation without having to suffer the full consequences. Well, a similar event occurs each fall between October 15 and December 7. This window each fall is called the Annual Enrollment Period, (abbreviated as AEP). This is the time of year for you to “Get Out of Jail for Free” from an undesired Medicare Part D Plan or an undesired Medicare Advantage Plan. I will take the next couple of paragraphs to define each situation.
Let’s say you are reading this article and have a Medicare Part D Plan that currently refuses to cover one of your regular medicines. The fancy term for this is the Drug is “not on the formulary” of that Part D Rx Policy. Sometimes, you can successfully appeal to the Insurance Company to have them make a “formulary exception”, (another fancy term) and cover the Drug, but that appeal may have been denied as well. So, the time is coming this fall where you can have me review your prescriptions and search for a new Part D Plan that will cover each of your medicines on the formulary of the new insurance company. NOTE: there is no Part D Plan that does NOT have a “Donut Hole” or “Coverage Gap” inside them in the area of higher cost Brand Prescriptions so changing plans does not make the Donut Hole disappear. If you have experienced this Hole or Gap you know it’s when your affordable copays at the pharmacy for your Meds seems to have disappeared and you now have to make a car payment or house payment at the counter to pick up your Medications.
The last situation that may have you longing to use your “Get Out of Jail Free Card” this fall is if you have a Medicare Advantage plan where you are finding it difficult to use the Hospitals, Clinics, Physicians, etc. that you want to see because you are told that they are “Out of the Plans Network”. I warn my clients all the time that as the monthly premium reduces toward $0 that many times you have to watch out for a restriction in your access to Providers (i.e. the Hospitals, Clinics, Physicians, etc.). So, the plans that have the lowest premium and lowest copays when you are treated seem to come with a lot me “restrictions” vs. the plans that have higher monthly premiums and lower copays.
Also, Medicare Supplements (another option for Health Coverage) have No Networks for you to have to contend with (maximum freedom), but the premiums are higher. But you won’t be paying copays to have diagnostic procedures or hospital stays for example.
The old saying is still true, “You Get What You Pay For” and this fall you have another chance to increase the quality of your health insurance if you are on Medicare. Just call my office on or after October 15th if you need any guidance on the decision that is best for you. You can reach Jack Bradley Agency at 706-778-2136 to set up an appointment time that is convenient for you.