Medicare Advantage Pre-Enrollment Checklist

Medicare Advantage Shopping List

Use this Checklist to Start Your Medicare Shopping List

AEP is almost upon us – it starts on October 15th and ends on December 7th!  Thinking of changing plans?  Where do you begin?

Having the wrong Medicare Advantage insurance plan can really hurt your pocketbook.  Medicare Advantage and Medicare Prescription Drug Plans change benefits every year.

By now, you should have received your Evidence of Coverage and Annual Notice of Change in the mail.  Insurance companies must mail these to you by September 30th every year.  Lucky for you, we’ve put together a nice little tool to guide you through the initial phases of the Medicare shopping process.

Because there are many different Medicare Advantage plans, and also because the benefits that are offered in such can be somewhat confusing for many folks, having a step-by-step form that walks you through the benefits, the costs, and the rules can be beneficial. That is just exactly what the Medicare Advantage Pre-Enrollment Checklist will do.

This is a starting point ONLY.  The first three steps are simply what EVERY person needs to do, every AEP.  The rest have more to do with special enrollment situations if you’re eligible for more specialized Medicare plans.

This checklist is outlined as follows:

_____ Review the full list of benefits that are discussed in the Evidence of Coverage – particularly for those services that you regularly see a doctor for.
_____ Review the provider directory (or ask your doctor) in order to ensure that the medical professionals you see now are in the plan’s network. (Note that if they are not listed, then it is possible that you will need to select a new doctor).
_____ Review the pharmacy directory in order to ensure that the pharmacy you currently use for prescription medications is in the network. (Note that if it is not listed, it is possible that you will need to select a new pharmacy).
Understanding Important Rules
_____ Acknowledge that in addition to your monthly Medicare Advantage plan premium, you are required to also keep paying your Medicare Part B premium. This premium is typically drawn directly from your Social Security income every month.
_____ The benefits, premiums, copayments, and / or the coinsurance requirement may change on this plan every year on January 1st, but changes can be found every year in your Annual Notice of Change (ANOC).
_____ For Medicare Advantage HMO (Health Maintenance Organization) plans other than for urgent or emergency situations, this plan will not cover services that you receive by out-of-network providers.
_____ If you are enrolling in a PPO (Preferred Provider Organization), a PFFS (Private Fee for Service), or other plan that offers out-of-network coverage, this plan may allow you to see providers that are outside of the plan’s network. The provider must first agree to treat you if you have a PFFS plan. Also, if you have a PFFS plan, other than in an urgent or emergency situation, an out-of-network provider may opt to deny you care.
_____ If you are enrolling in a C-SNP (Chronic Condition Special Needs) plan, your ability to enroll will be based on verification that you have a qualifying specific severe or disabling chronic condition.
_____ For D-SNP (Dual Eligible Special Needs) plans, your ability to enroll will be based on verification that you are entitled to both Medicare and medical assistance from a state plan under the Medicaid program.
_____ For I-SNP (Institutional Special Needs Plans), your ability to enroll will be based on verification that you, for 90 days or longer, have had or are expected to need the level of services provided in a long-term care skilled nursing facility, or other qualifying facility.
_____ For I-SNP plans that are accepting members who do not yet have 90 days of institutional level care, your ability to enroll will be based on verification that your condition makes it likely that either the length of stay or the need for an institutional level of care could be at least 90 days.
_____ For MSA (Medicare Medical Savings Account) plans, this plan combines a high deductible Medicare Advantage plan and a trust or custodial savings account. The plan deposits money from Medicare into the account. You can use these funds for paying for your health care expenses – but only Medicare-covered costs will count towards your plan deductible. The amount of money that is deposited is typically less than the amount of your plan’s deductible. Therefore, you oftentimes will need to pay at least some amount of out-of-pocket expenses prior to your coverage starting to pay. In addition, Medicare MSA plans do not cover prescription medications. Therefore, if you opt for an MSA plan, then you are also allowed to enroll in any available Medicare prescription medication plan.

This is a special time of year – and one that you CAN do yourself.  If you’re comfortable with the basics of Medicare, then dive right into Medicare’s enrollment tool and start shopping.  If you’re not, or would like the advice of a local Medicare insurance sales agent, pick up one of those direct mail pieces sitting on your counter and give them a call.  Someone from the insurance company will answer.  Request an “in-home appointment” and tell them what kind of plan you’re looking for.  Odds are, they’ll send an independent agent out to your home (or location of your choice) to explain your coverage to you, and the other coverage available in your area.

Take this checklist.  Ask your agent to run you through it.  Odds are, they’ll be more than happy to oblige.  How do you know if you’ve got a good agent?  Check this post out.  It’s a long one, but a good one if you want to make sure you’ve got a great Medicare insurance agent.

Happy (almost) AEP!

Source

Medicare Communications and Marketing Guidelines (MCMG). July 20, 2018. Appendix 3 – Pre-Enrollment Checklist. (https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/CY2019_Medicare_Communications_and_Marketing_Guidelines.pdf)