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Latest news and updates about the Medicare and pharmacy industries.

New Medicare Special Enrollment Periods and What You Can Do

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Beginning in 2019, there will be a new Open Enrollment Period for Medicare Advantage. This period will run from January 1 – March 31. If any of your patients are enrolled in a Medicare Advantage plan, they have a one-time opportunity during this period to:

Switch to a different Medicare Advantage plan, 

–OR–

Drop their Medicare Advantage plan, return to Original Medicare (Parts A and Part B), and enroll in a stand-alone Medicare Part D Prescription Drug Plan.1

Background

Medicare beneficiaries are increasingly enrolling in Medicare Advantage Plans instead of Original Medicare with a stand-alone Prescription Drug Plan. The percentage of Medicare beneficiaries on Medicare Advantage plans more than doubled from 16% in 2006, to 33% in 2017 2. Advantage plans differ from original Medicare in that they have limited, sometimes closed doctor networks. Some Advantage plans offer additional benefits, like coverage for hearing, dental, and vision. If patients are unhappy with their current benefits, but missed the opportunity to review their plan options, this new Open Enrollment period offers an extension for patients to find the right coverage.

What this means for you

For pharmacies, this means you have the opportunity to offer knowledge and guidance for your Medicare Advantage patients until the end of March. If patients express frustration or concern about their current insurance plan, check their current enrollment; if they’re enrolled in a Medicare Advantage plan you can help them enroll in a plan better suited to their needs! 

Pro-tip: Consider developing this opportunity into a marketing campaign to increase community awareness and gain new business. A few well-placed flyers and a facebook post can go a long way. 

Resources

The Pro’s and Con’s of Medicare Advantage

Medicare Advantage Plan Comparisons 

New Special Enrollment Periods for Dual Eligible Beneficiaries

Beginning in 2019, dual eligible patients (patients on both Medicare and Medicaid) will only be permitted to change their Medicare plan once every quarter from January to September. This is a big change from the previous regulation, which allowed such patients to change plans once a month.

Background

The official policy states, “to ensure that Part D plan sponsors are better able to administer benefits, including coordination of Medicare and Medicaid benefits, we are revising the Special Election Period (SEP) for dual-eligible and LIS beneficiaries from an open-ended monthly SEP to one that may be used only once per calendar quarter during the first nine months of the year.” 3

What this means for you

For pharmacies, this means there are increased limitations on how often you can help your dual eligible patients enroll in a new Medicare plan. Because of this, we recommend focusing on your dual eligible patients with a regular cadence at the beginning of each quarter — January, April, and July.

Resources

Dual Eligibility explained

Best practices for Dual Eligible plan comparisons

[1]: https://medicare.com/medicare-advantage/new-open-enrollment-period-for-medicare-advantage/

[2]: https://www.nytimes.com/2018/07/20/health/medicare-advantage-benefits.html

[3] https://www.cms.gov/newsroom/fact-sheets/cms-finalizes-policy-changes-and-updates-medicare-advantage-and-prescription-drug-benefit-program

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