Mysteries of Medicare: Time to review your Medicare coverage

If you are on Medicare and have a Medicare Advantage Plan (Part C), or Medicare Prescription Drug Plan (Part D), you have an opportunity to change your coverage during this year’s Medicare Annual Enrollment Period (AEP), which runs October 15 through December 7. Any coverage change you make during this period would go into effect January 1, 2018.

The Centers for Medicare and Medicaid Services (CMS) has reviewed insurance company proposals for 2018 and as of October 1, new information on these CMS approved products will be available to beneficiaries for comparison.

Beneficiaries will also soon receive their Annual Notice of Change for their current plans. This document provides details on premium changes, co-pay changes and formulary (drug tiers and coverage) changes. It is critical to review any changes to make sure that the medications you take will continue to be covered by your
insurance plan.

Medicare Advantage beneficiaries can also expect to receive Annual Notices of Change regarding their HMO/PPO plans. In addition to reviewing details on premium, co-pay and formulary changes, Medicare Advantage beneficiaries must also review that their chosen doctors and hospitals will continue to belong to their plan’s network in 2018.

Supplemental plans (also known as Medigap Policies) are not affected by the Annual Open Enrollment Period. Their premiums depend on approval by the Pennsylvania Department of Insurance. If your rate increases, you may or may not be able to change, and depending on your particular supplement and health status, you may be subject to medical underwriting should you chose to change your Medigap coverage.

If you are a low-income Medicare beneficiary, and do not currently receive any Medicare Savings or Extra Help Program subsidies, you may be eligible for assistance with your plan premiums and out-of-pocket Medicare costs through various State and Federal Medicare Savings and Low-Income Subsidy and PACE programs. APPRISE counselors can help beneficiaries determine if they are eligible and provide application assistance for these Medicare cost savings programs.

Medicare Annual Open Enrollment: Five things you need to do

Routines help to keep us focused, organized and healthy; however, if your health routine does not include preparing for Medicare’s Annual Open Enrollment Period, now is the time to kickstart a new healthy habit.

If you have Original Medicare, Medicare Advantage Plan (Part C) or a Medicare Drug Plan (Part D), the upcoming Medicare Open Enrollment Period (October 15 through December 7) is the time you can make changes to your coverage. Even if you are happy with your current coverage, you may find coverage options that are a better fit for your budget or health needs. In most cases, if you choose not to make changes to your coverage during Medicare’s Annual Fall Open Enrollment Period, you will most likely have to wait a full year before you can make changes to your plan.

These are a few easy ways to get a jumpstart on your benefit options for Medicare’s Annual Fall Open Enrollment Period. For more information, or to set up an appointment for Medicare’s Annual Open Enrollment Period, contact APPRISE through the Butler County Area Agency on Aging at
(724) 282–3008 or contact Medicare directly at (800) 633-4227. 

The Butler County APPRISE Program will be conducting Medicare Open Enrollment Period Plan Comparison Appointments from October 15 through December 7 at the Butler County Area Agency on Aging offices, located at 111 Sunnyview Circle, Suite 101 in Butler, and will also be holding satellite appointments on specific days/times at the Cranberry Township Senior Center, 2525 Rochester Road, Cranberry Township. Plan reviews for both location are by appointment only and must be made in advance by contacting the Area Agency on Aging Apprise Program at (724) 282–3008, or by email request to

Here are five important things that every Medicare beneficiary can do to get in the Medicare Annual Open Enrollment Period routine.

  1. Review your plan notice. Be sure to read any notices from your Medicare plan about changes for your 2018 coverage, especially your “Annual Notice of Change” letter. Look at your plan’s information to make sure your prescription medications are still covered and that your preferred doctors and specialists are still within the
    plan’s network.
  2. Think about what matters most to you. Medicare health and prescription drug plans change each year and so can your health needs. Do you need a new primary care doctor? Does your network include the specialist you want for an upcoming surgery? Is your new medication covered by your current prescription drug plan? Does another plan offer the same benefits at a lower cost? Take stock of your health status and determine if you need to make a change.
  3. Find out if you qualify for help paying for your Medicare premiums. Learn about programs in Pennsylvania that help with the cost of Medicare premiums, Medicare Part A and Part B coinsurance, deductibles, co-payments and Medicare prescription drug coverage costs. For more information on whether you may qualify for a Medicare Savings Program, Medicaid, Social Security’s Extra Help with Prescription Drugs Program, or Pennsylvania’s PACE/PACENET Programs contact the APPRISE Program at the Area Agency on Aging by calling (724) 282–3008 for a benefit screening.
  4. Shop for plans that meet your needs and fit your budget. Beginning October 1, you can use Medicare’s plan finder tool online at to see what other plans are offered in Butler County.
  5. Check your plan’s start rating before you enroll. Medicare’s Plan Finder Tool has been updated with 2018 Star Ratings for Medicare health and prescription drug plans. Plans are given an overall quality rating on a 1 to 5 star scale, with 1 star representing poor performance and 5 stars representing excellent performance. Use the Star Ratings to compare the quality of health and drug plans being offered. It is important to note that there are currently no 5 star plans in Pennsylvania.

By Brittany Buzzelli, Community Liaison/APPRISE Coordinator Butler County Area Agency on Aging
For Butler County Senior News