Open Enrollment – Helping People with Medicare Make the Best Decisions for their Health

SUMMARY
As a contractor for Medicare, Acentra Health serves as the Beneficiary and Family Centered Care Quality Improvement Organization, also referred to as a BFCC-QIO. While Acentra Health provides BFCC-QIO services in 29 states (visit www.acentraqio.com to see the states served), the general information is relevant to everyone who has Medicare (including Medicare Advantage) and everyone who works with people who have Medicare.  

This episode is a conversation with our guest, Kathy Madden who works for the Colorado Department of Regulatory Agencies, Division of Insurance. She has been the State Health Insurance Assistance Program (SHIP)/Senior Medicare Patrol (SMP) Partners Services and Training Manager for 12 years. She spent most of her career training all over the country on various topics in the Human Services realm before joining SHIP.  

She has experience and knowledge about Medicare, Medigap, Medicare Advantage, and Medicare-related topics. Kathy is passionate about advocating for seniors and understands that consumer education is key to beneficiaries making information Medicare decisions and preventing fraud and abuse within the Medicare program. She is excited and honored to help consumers, stakeholders, and partners navigate the complex Medicare system.  

For more information about Acentra Health BFCC-QIO, please visit https://www.acentraqio.com. 

KEY TOPICS  
00:25: Overview, introduction of guest, Kathy Madden 
02:25: Information about the SHIP program 
04:30: What is Medicare Open Enrollment? 
07:58: What is Medicare Advantage Open Enrollment? 
11:46: Medicare Plan Finder tool 
14:47: Summary and final thoughts 

SUBSCRIBE
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RESOURCES
BFCC-QIO Information for stakeholders: www.acentraqio.com/partners 

BFCC-QIO Information for people who have Medicare: https://www.acentraqio.com/bene/helpline 

SHIP and Senior Health Insurance Benefits Assistance Program (SHIBA): https://www.shiphelp.org/ 

Medicare: https://www.medicare.gov/ 

Music: Motivational Upbeat Corporate by RinkevichMusic

https://soundcloud.com/rinkevichmusic
https://protunes.net/
Video Link: https://bit.ly/3NNqGTs 

Transcript

Scott Fortin 

Welcome to Aging Health Matters, a podcast from Acentra Health, a Beneficiary and Family Centered Care Quality Improvement Organization. We plan to cover healthcare topics for the Medicare population. Information in today’s show may help you or someone you know in their heatlhcare journey. Thanks for joining us. Now let’s get started. 

Nancy Jobe 

Hello everyone. I am Nancy Jobe, an Outreach Specialist for Acentra Health. Acentra Health is the Beneficiary and Family Centered Care Quality Improvement Organization providing services for Medicare beneficiaries in 29 states. We have three key services for people who have Medicare: beneficiaries have a right to appeal discharges from the hospital and skilled service terminations. Acentra Health helps beneficiaries with Immediate Advocacy to resolve medical care issues they may encounter, and beneficiaries can file a quality of care complaint. More information is available on our website at www.acentraqio.com. 

We also work with many outstanding partners to help spread information about the Medicare program and its benefits. While we greatly appreciate their partnerships, we also want to be clear that the opinions and guidance expressed by them in this podcast are solely theirs or their agencies and are not necessarily those of the QIO, CMS, or the Medicare program. Please keep in mind that state-by-state guidance may differ as well. Well today we'll be learning about the different parts of Medicare, including the Open Enrollment program. And we have Kathy Madden, a Director of the Colorado State Health Insurance Assistance Program or the SHIP. And she's going to talk to us a little bit about Open Enrollment and how that all works. But before we start with that, Kathy, can you tell us a bit about your background? 

Kathy Madden 

Of course. So my name's Kathy Madden. I am the Colorado SHIP Partners and Training Manager, and I have worked with SHIP for over 10 years. Primarily my job with SHIP is to make sure our counselors in Colorado are trained to do this SHIP work. They have to go through a certification process. I also handle referrals that come in around the state. I do the complaints for Medicare Advantage and Part D plans, and I'd say other duties as assigned. 

Nancy Jobe 

Thank you Kathy. You have quite an extensive background helping beneficiaries. You mentioned the SHIP organization. Could you tell us a little bit more about what they do?  
Kathy Madden 

Yes. So the SHIP program is the Senior Health Insurance Assistance program, and it's a national program that helps Medicare beneficiaries, their families, and caregivers make informed decisions about their health care and benefits. SHIP offers counseling, education, and one-on-one assistance. We help people understand their health coverage and costs, so they can make the best choice for their needs. We are known for being trusted, unbiased one-on-one counseling and assistance. SHIP services are available to Medicare beneficiaries, Medicare beneficiaries under 65 with disabilities, people who are dually eligible for Medicare and Medicaid, and people with limited incomes. The SHIP services are delivered by state units on aging or state departments of insurance, and we are all over the US. 

We reach approximately 4 million beneficiaries during Open Enrollment every year, which makes up about 40% of our yearly contacts. There are 54 SHIP grantees all around the country in the world, one in every state, plus Puerto Rico, Guam, DC, and the Virgin Islands. And just a quick fun fact, SHIPs are not called SHIPs all over the country. You'll also hear them referred to as SHIBA, SHINE, SHIP, so it really depends on the state you're in, what the SHIP program is called. 

Nancy Jobe 

That is good to know because I know in my state it's the SHIP, but I think in Florida it's SHINE. And it does get a little bit confusing for some people. Where can they find out how to contact the SHIP in their state? 

Kathy Madden 

So to contact the SHIP in your state, you want to call 888-696-7213 and enter in your county of residence, and you'll be directed to your local SHIP affiliate. 

Nancy Jobe 

That's great information. Thank you so much. I know the fall is a big time of year for the SHIP programs. They stay very, very busy talking about and enrolling people in the Medicare Open Enrollment period. Can you tell us what that is when everybody hears about Open Enrollment and what they need to do at that time? 

Kathy Madden 

Sure. So the Medicare Open Enrollment is our busiest time of the year. It's the yearly period when Medicare beneficiaries can review and change their health and drug plans for the following year. So the 2024 Open Enrollment period is October 15 through December 7, and that's every year, no matter which days those dates fall on, and during Open Enrollment, people can join, switch, or drop a Medicare Advantage plan. They can switch to original Medicare, or they can choose to keep their current coverage. Medicare plans can change each year, however, including the costs, the coverage, and the providers. So comparing plans during Open Enrollment can really help people find better coverage or sometimes save money. 

Nancy Jobe 

I know you mentioned that they can change the Medicare Advantage plan. Can they also at that time, don't they change their prescription drug plans as well? 

Kathy Madden 

They certainly can. So they can, I'm sorry. I didn't mention that, they can change their prescription drug plans as well, and we do encourage people to do that every year because like I mentioned, those things can change. And the last thing you want to do is January go fill a prescription, and it's doubled because you didn't,compare your coverage to see if maybe there was a better Part D plan out there for you. 

Nancy Jobe 

Very good point you make there because I know that I know at this time of year everybody's getting all these mailings and for the Medicare Advantage or trying to get you to change and this kind of thing, but you also get a notice from the prescription plan that you are on now, whether it be a Medicare Advantage or just a standalone prescription plan, and people really need to look at that and then decide about making that comparison, and they would do that by calling one of your counselors. Is that correct? 

Kathy Madden 

That is correct, yes. So during Open Enrollment, Medicare beneficiaries, like I said, they should review their current coverage and compare it to other plans. As long as they make plans during this period, the coverage will take effect in January. And like I mentioned, they can change their Medicare Advantage plan, their Part D plan. They can switch to original Medicare from a Medicare Advantage plan. I mean it's limited in what you can do, but it is the time of year to do it. Before making a decision about 2025 coverage, SHIP helps beneficiaries consider their plans in their area, and it is really important to check because you might be able to receive the same or better health care at a more affordable price. We really do encourage people to do that. We can also help Medicare beneficiaries find financial help paying for these Medicare costs. 

Nancy Jobe 

That is another good point because I know I have several friends that are on Medicare, and they’re diabetics, and they got a notice that their prescription drug plan wasn't going to cover the medication that they use. So they were able to do a comparison to find one that actually would cover the medications that were on there. So that comparison is extremely important to do because if you wait till January, now you can't make that change. Correct? 

Kathy Madden 

That is correct. I do want to mention without confusing the audience though. There is what's called a Medicare Advantage Open Enrollment that happens in January, and it's good from January 1 to March 31. And if you were on a Medicare Advantage plan on December 31 of the previous year, you are allowed to change during those first three months of the year to a new Medicare Advantage plan. You can go back to original Medicare and perhaps get a Medigap with a a standalone Part D plan. So that does kind of help people who maybe didn't make that change during Open Enrollment, and they get surprised January 1. There is an Open Enrollment period for those folks only. If you were on original Medicare on the 31st of December, that Open Enrollment period would not apply to you however. 

Nancy Jobe 

OK. So if a person had original Medicare and maybe a supplement and a Part D plan, they would need to be sure to make that decision by December 7, by the end of Open Enrollment. 

Kathy Madden 

That is correct. 

Nancy Jobe 

OK But if they're on a Medicare Advantage plan, then. And get surprised in January, they’re covered. 

Kathy Madden 

That is correct. And some of the things that we find that we get these calls in January are Medicare drug plan formularies have changed, and the drug they need is not on the formulary. They did not check if the doctor was on the new plan, and that doctor isn’t, and now they want to go back to their doctor. Those kinds of things.  

Nancy Jobe 

Another point to make for those people on a Medicare Advantage plan because I know right here in my area, one of the local hospital systems said that they were going to be dropping the Medicare Advantage plan. So that is something to be aware of.  

Kathy Madden 

Absolutely. And be looking out for those mailers that come from the plan. That is so important, that when you get something from a plan that you are currently on, to open it and read it and take action. We find a lot of people don’t. They get so much junk mail that they don’t open it all. But if you get something from the plan that you are currently on, it’s really important to open it, especially right before Open Enrollment, around the end of September, early October. The plans will send out what is called an Annual Notice of Change or an ANOC or an Evidence of Coverage or EOC. And those things list anything that is changing in the plan for the upcoming year. And they are mailed to your house, so please, any mail that comes from your current plan around the end of September or early October, open it and read it because it is going to give you the changes for the upcoming year.  

Nancy Jobe 

Is that true for prescription drug plans too? They’ll send the same type or notification or is it just Medicare Advantage? 

Kathy Madden 

It is Medicare Advantage and standalone Part D plans. 

Nancy Jobe 

Perfect. That’s a lot of information for everybody to know, but it’s so important because if you don’t make that decision by December 7, come January, now you are into 2025, and you are going to be with whatever plan you are on.  

Kathy Madden 

And it’s really important to pay attention to the plan costs, the benefit changes, the rules, and the list of drugs that the plan covers. To me, the most important thing that drives picking a plan for somebody, the question is are all your drugs on that plan’s formulary. To me, that drives the choice of picking a plan. You want to make sure that all your drugs are covered. The last thing you want to do is go in in January and find out an expensive drug is not covered.  

Nancy Jobe 

That’s a good point to make because a lot of people just look for the cheapest plan and not even enter their drugs. When you say there is a comparison, even if they don’t use the SHIP program, they can go to Medicare.gov. What is the website they can go to and actually do this themselves if they feel confident? 

Kathy Madden 

Yes. It is medicare.gov. You can certainly go there. It's very intuitive. They ask you about five questions. It moves you right through the process, and then at the end, it gives you all of the plan options that you have, and it is sorted least expensive to most expensive. So it really spells it out for you. But that is really important for somebody to go and check out. 

Nancy Jobe 

And they're entering each one of their drugs into there. So it's going to bring up the best plan for them specifically. Correct? 

Kathy Madden 

That is correct. So when you're entering in drugs what wee ask. We get a drug list from the beneficiary. We need the correct name and spelling of the drug. We need the dosage, jow much you take, the frequency, how often you take it. I like to know what kind of drug it is because there's so many drugs out there. Is it a pill? Is it a capsule? Is it a spray? An ointment? Injectable time release? What is it? So we can make sure we pinpoint your drugs and whether or not you can take a generic or if you have to stick to the brand. Those are the things we need in creating your drug list. Once we put your drug list in, and this is a good point I wanted to make, is that if you create an account on Medicare.gov, then all of your Medicare history is going to be housed there.  

Now I know the last thing people want to do is create one more account for themselves, but I tell Medicare beneficiaries if you're going to create one more account, this is the one to create because there's never any questions about when you went to see a doctor or what it was about and who the doctor was. Your drug list is automatically updated when you go to the pharmacy, so if they add a drug, it's going to be added on Medicare.gov. Another pro to having a Medicare.gov account is that when you come to SHIP for help, if you give us your user name and password, when we go in to look for plans for you, all your drug list is there. Your current plan is there, your history of your plans is there. 

So if I ever have to do a complaint for somebody and they say, well, I can't remember the plan I was on when this happened. I can go back to Medicare.gov and tell them exactly what plan they were on within certain dates. So Medicare.gov, have an account there I think is really, really is something that's important. If we can talk Medicare beneficiaries into doing it, they absolutely love it. And it's much easier to look for a plan if you have a Medicare.gov account. Because it brings up your specific information. And again, like I said, you don't have to reenter those drugs every time. 

Nancy Jobe 

That's a good tip right there for sure to share with everyone. I think that this is such an important time of year for everyone, and it's so important for them to really look at it because it financially affects them in the next year, and it's really an important piece of information that we can share with everyone there. If you were to summarize it all up into a big ball of what we've talked about today, what would you have to say? 

Kathy Madden 

I think I would say don't get overwhelmed. I would say carve out some time to look at your plan for the upcoming year again. Look at your annual notice of change or your evidence of coverage and just look at your coverage to see if it's the same, and you can live with the changes. Then you don't have to do a thing during Open Enrollment. Right? But. If you look at that and you think, wow, these costs are going up. Please go ahead and call SHIP. You don't have to go it alone during this time. That's what SHIP is here for. We love our beneficiaries. We love educating our beneficiaries. I have people that call me every year like clockwork because they want to look at their plan. We sort of taught them. It's very important for you to look at your plan. So I get to hear from my old buddies every year because they call to have me compare plans or whatnot. So I would say just don't get overwhelmed by the process because we hear that a lot. Just pick up the phone and give SHIP a call. We are happy to help. We will walk you through everything and make sure you're on the best plan for the upcoming year. 

Nancy Jobe 

Thank you so much Kathy for being our guest today. You have shared quite a bit of important information about the Open Enrollment period that all of our audience needs to hear. If you have any other questions about your Open Enrollment, please contact the SHIP in your state. And we will have in our Show Notes the number to call that is for your state. Thank you again for listening to Aging Health Matters. And we look forward to sharing more information with you in our upcoming podcast.  

Outro 

If you would like more information about our services for Medicare beneficiaries, please feel free to sign up for our newsletter and subscribe to our YouTube channel. Our Helpline phone number and the link to sign up for our newsletter are available on our website, which will be in the Show Notes. We also have helpful resources available on the website as well. Thank you for joining us today, and please stay tuned for the next episode of Aging Health Matters.