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Medicare Open Enrollment: What Physicians and Patients Need to Know

October 20, 2009

Medicare Open Enrollment is quickly approaching, and Health First Network encourages its physicians to support their patients through this process. Please note that Health First Network only has contracts with two Medicare Advantage plans at this time, WellCare and HealthSpring. Key dates, patient tips, and helpful information are included in this article.

Key dates to keep in mind and share with patients:

Sneak Peak
October 1, 2009: This marks the day that health plans can begin to offer a "sneak peak" of what's to come. It is when health plans begin to advertise what their new plans will look like, generally speaking.

Full Disclosure
Mid-October: Medicare will disclose all of its plans in full. This is when physicians and patients will learn anything and everything there is to know about 2010 plans and benefits.

Medicare-eligible members should watch their mail for notices from Medicare, Social Security and health and drug plans with information about changes in 2010.

Members can compare plans online at starting October 15, 2009.

Annual Enrollment Period (AEP)
Medicare-eligible members can make changes to their Medicare health or prescription drug coverage between November 15 through December 31, 2009. During this period, Medicare patients have the most flexibility. They can choose to enroll in Medicare Advantage or, if they are already Medicare Advantage members, they can change plans. People have the option of making more than one change; however, it is important that they understand that the application with the latest date will become effective on January 1, 2010.

Open Enrollment Period (OEP)
January 1 through March 31, 2010: In this time frame, eligible individuals may make ONE change to a plan centered on their Part D coverage. This means that if an eligible person is in a plan that has no Part D coverage, they may only change to another plan with no Part D coverage.

Special Enrollment Plan (SEP)
In certain cases, qualified individuals may enroll in, disenroll from, or change to a different Medicare Advantage plan or Original Medicare. Time frames for this kind of enrollment are determined on case-by-case scenarios. SEP situations might include:

• Changes in residence
• Turning 65
• Termination of a Medicare Advantage contract

Enrollment for Dual Eligibles
In addition to the enrollment periods listed above, please note and let patients know that individuals who are dual eligible - meaning they qualify for Medicare AND Medicaid - benefit from a permanent open enrollment period. This group can make changes to their plans anytime during the year.

Tips to offer patients regarding the Medicare Enrollment process:
• Be open to switching plans. New plans will be introduced this fall. This means more options from which to choose. People with Medicare should check to make sure their plan still meets their needs and budget. There may be a Medicare health or drug plan available with better coverage or a lower deductible in 2010.
• Learn about each plan to determine which one is the best fit. Every person is different…so is every plan.
• Pay special attention to the pharmacy benefits/drug formularies. This is especially important for patients who rely heavily on medications.
• Don't wait until the last minute. Every senior in America is making a decision regarding health care. The earlier individuals submit paperwork, the quicker it will be processed.

Additional helpful information regarding enrollment:
• To get your Medicare questions answered, call the Medicare Helpline at 1-800-Medicare
• Or visit to get more information on Medicare, find programs that may help with your prescription drug and other health plan costs, download booklets and compare health plans, prescription drug plans, hospitals, nursing homes and more.

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