Medicare Alphabet Soup: AEP and OEP

“If I knew I was going to live this long, I’d have taken better care of myself.”

So said Eubie Blake, composer, lyricist and pianist of ragtime, jazz, and popular music, who died in 1983 at age 96.

Selecting the Medicare healthcare coverage that helps you take the best care of yourself and fits your changing needs is crucial, and the time to review your plan is only a few short weeks away.

The Annual Enrollment Period (AEP) for Medicare Advantage plans and Medicare Prescription Drug plans, beginning October 15 and running through December 7, provides those on Medicare an opportunity to change their medical and prescription drug coverage for 2019.

Before, the plan you selected during AEP was in place for a year, unless you qualified for certain events permitting a plan change.

The Centers for Medicare and Medicaid have now reinstated the Open Enrollment Period (OEP), offering new options for you. The dis-enrollment period, January 1 to February 14, is replaced by the Open Enrollment Period from January 1 to March 31. Those enrolled in a Medicare Advantage Plan may dis-enroll from that plan and select a new Advantage Plan one time only. This allows beneficiaries to change from one like plan to another like plan. Beneficiaries may also dis-enroll from their Medicare Advantage Plan and revert to Original Medicare, and add a Medicare supplement and/or a prescription drug plan. The new plan will be effective the first day of the next month after the change.

Your action steps:

Review your plan’s notices

Your plan’s Annual Notice of Change lists changes to your benefits and plan rules effective January 1, 2019. This may affect your prescriptions, co-pays or the doctors you prefer. Read every letter received from your Medicare plan about any other plan changes for next year.

Consider what matters most

Has your health changed in 2018? Will your current plan meet these needs? Does another Medicare plan offer better options, or pricing?

Don’t delay! Review all your options

While AEP runs from October 15 to December 7, all plan changes will be available October 1. Consult with your broker or agent about your options, including a Medicare Supplement (Medigap) with a prescription drug plan. You can change your plan for 2019 beginning October 15, but not before.

Live long and prosper, but take a hint from Eubie Banks: Get your 2019 health plan facts before those facts get you. Your health and peace of mind depend on it!

Mail Order Drugs

Do you like the convenience of receiving your prescription drugs through the mail order feature of your Medicare Part D prescription drug plan? Do you dislike having to call the mail order pharmacy to request your refills? Are you wondering why the plan doesn’t just send your prescriptions every 90 days without requiring you to contact them to authorize your refill?

You’re busy, and if you are like me, you automate as much of your daily routines and responsibilities (such as ordering your meds) as you possibly can. Here’s some information that may be useful for you.

Medicare prescription drug plans must have your approval to deliver a prescription drug (new or refill) unless you ask for the refill or request the new prescription. Some plans may ask you for your approval annually so that they can send you your drugs without asking you before each refill delivery. Other prescription drug plans offer an “automatic refill” service that automatically delivers prescription drugs when your prescription is about to run out.

Certain plans may ask you before every delivery. This policy doesn’t affect refill reminder programs where you go in person to a retail pharmacy to pick up the drug, and it doesn’t apply to long-term care pharmacies that dispense and deliver prescription drugs.

Call your plan’s mail order pharmacy or visit the plan’s pharmacy section on their website to see what features are available to you. You’ll learn the best way to make the refill process go smoothly. The plan may suggest downloading an application if you are a smart phone user that you use to authorize refills. Be sure to give your pharmacy the best way to reach you, so you don’t miss the refill confirmation call or other communication.

Lastly, should you ever receive any unwanted or unordered prescription drugs through an automated delivery program, contact the plan’s mail order pharmacy immediately to investigate for fraudulent use of your information. If you receive a refill for a medicine you’ve canceled or changed, you may be eligible for a refund for the amount you were charged. If you aren’t able to resolve the issue with the plan or wish to file a complaint, follow the instructions in your plan’s Evidence of Coverage to file an appeal. If your situation cannot be resolved, contact 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Leah Kari, CRM, a retired pharmaceutical representative, is a licensed life and health insurance broker in Tucson. Reach Leah for comments at 520-484-3807 (TTY users dial 711) or email