Navigating the world of healthcare and insurance, especially Medicare, can be very complicated and overwhelming. It's important to make the right decisions when it comes to health insurance plans and to understand the available options that could impact the critical care you need.
According to Dr. Neil Thakur, chief mission officer for The ALS Association, about 70% of the people the Association serves are already on Medicare. “It is complex, especially if you're going to go into one of the Medicare Advantage Plans, because those plans are also different in terms of the kind of support that you can get and the providers that are available to you in your area,” he said in a recent Connecting ALS podcast. “You may want to use one portion of Medicare, the managed care program and the Medicare Advantage program, when you're early on in your ALS experience, but as you progress, you may want something a little bit more intensive and regular, like the traditional plan.”
To help the ALS community better manage this challenging process, the Association partners with the Patient Advocate Foundation (PAF) to provide The Medicare Resource Line, a free resource designed to give individualized case management assistance for people living with ALS, their family members and caregivers. “Our case managers actually work with thousands of patients with all different kinds of health conditions,” says Courtney Jones, senior director of case management at the PAF. “We work with healthcare providers, insurance companies, charities and many other entities across the country to find programs and services that fit the patient's needs. We help patients gain access to prescribe medical treatment and services, help in understanding what health insurance covers, and options available if they find themselves without health insurance”
According to Courtney, any changes made during this open enrollment period, October 15th through December 7th, will take effect January 1st of 2022. “If you miss the open enrollment and you don't qualify for a special enrollment period, you will have to wait another year for the next open enrollment period to make changes to your Medicare plan,” she said.
“It's really important that individuals start to think about their Medicare coverage and what that will look like in 2022, carefully reviewing their current Medicare coverage and noting any upcoming changes that they may have to any treatments or therapies, any tests or medications that they have, decide if their current Medicare coverage will meet their needs for the year ahead, and if they're dissatisfied with the coverage they currently have, make that change during open enrollment.”
“Also, another tip is, before you enroll in a plan, I always tell the member to confirm all the details about the new plan within the plan itself,” she said. “If you're looking at a Medicare Advantage Plan, reach out to that Medicare Advantage Plan, ask some of the specific questions on coverage and confirm what you are seeing online, that those are true in the detailed plans itself. Write down everything about the conversation that you have when you're enrolling through the phone, including the date and the representative you spoke to and any outcomes or next steps that they require.”
Courtney also shared examples of some of the most commonly asked questions they receive from families through the resource line.
"What if I don't like my Medicare Advantage Plan that I selected during open enrollment? What are my options?"
According to PAF, all Medicare advantage enrollees have a one-time trial period that runs for the first year that you elect a Medicare Advantage Plan. “If you elected a Medicare Advantage Plan as soon as you were Medicare eligible, or if you elected to a Medicare Advantage Plan during open enrollment, at any point during that year you can switch back to your original Medicare,” says Courtney. “That does give you some flexibility. If you're looking to try a Medicare Advantage Plan and then find that it is not for you, you do have that one-time option to switch back to Medicare original, which is your A and B.”
"What if I elect a Medicare D plan, but I need to change that because my medication is no longer covered, or my medication changed? What are my options outside of open enrollment?"
If you qualify for a low-income subsidy, also called extra help, your enrollment in Medicare Advantage Plans and Part D prescription drug coverage is not limited to this open enrollment period. “If you qualify for extra help, you can make changes to your Medicare Advantage or your Part D prescription coverage up to once per calendar year. That gives you an opportunity to change as your medications may fluctuate based on therapy,” she said. “But that, again, is only for those that qualify for low-income subsidy or extra help through Social Security.”
"Is there any assistance available to help me pay my Medicare premiums for medical costs?"
Courtney explains some people find the available options may not be affordable to them and they're hesitant to make any enrollment changes or to enroll at all. “There are Medicare beneficiaries that have low incomes or low assets that could qualify for Medicaid coverage, it's also called the Medicare Savings Program,” she said. “That can help pay for Medicare premiums, co-pays, deductibles and co-insurances. To look to see if you're eligible or what your state's eligibility criteria is, I recommend individuals reach out to your local human services department, or it could be called your social services department. They can look at the Medicaid and Medicare Savings Program eligibility criteria to apply.”
"How do I know if my Medicare coverage will follow me if I have to move out of state?"
Courtney says that “if you're enrolled in your original Medicare, which is your Part A and B, then yes, that will follow you as you move from state to state, you would just need to notify Medicare that you have moved and where you currently reside. However, if you have a Medicare Advantage Plan, a prescription Part D plan, then you would have to look at another policy because those can be state specific. If you are moving, that does open the ability, outside of this general open enrollment time, to elect another plan. You would just have to contact them to tell Medicare that you are moving, and you need to elect another Medicare Advantage or Medicare D prescription plan.”
“If anyone is currently living with ALS and needs assistance, I would encourage you to reach out to your local ALS Association chapter who can then refer you to our ALS Medicare resources,” said Courtney.
For a more information about eligibility for Medicare, Medicaid and other insurance options, view our webinar HERE.
To listen to the full Connecting ALS podcast episode, “Medicare Open Enrollment…”, CLICK HERE.