Elder Law attorney and passionate special needs advocate Jim Koewler joins Suzanne to talk about open enrollment, and the insurance changes that go on at the end of each year that lead in to the open enrollment period.
From October 15 to December 7 is annual enrollment, when people who are on Medicare Advantage plans (or have other coverage providing a prescription plan) need to see if their current plan is appropriate for them for the coming year. Some people let it ride, while many others shuffle into new plans, because the types of covered medicines can change.
If you change your mind aft December 7, you can change plans from January through March, during a period called open enrollment. Neither period lets you jump into a Medigap Insurance plan if you can’t qualify for it, but you can move between Advantage plans. A Medigap plan can accept you at various times, but after those periods of eligibility they don’t have to accept you.
Jim describes other sorts of circumstances. For instance, if you want to change from Medicare Advantage to a supplement after the enrollment plan, you have to apply, and an underwriter may interview and evaluate you in person.
Learn more at http://www.protectingseniors.com or email Jim at [email protected].
Suzanne: And welcome, everyone, to Answers for Elders Radio network, heard in 24 markets across the United States. Also on https://answersforelders.com, https://www.seniorresource.com/, your favorite podcast portal, and also YouTube at https://www.youtube.com/channel/UC741tjwYgjuE2GDQpdiGPwA. For those of you that want to watch our interviews at times, you can check out all kinds of content with us, and we’re so glad to be coming to you across the USA.
And this is the time for many seniors that there’s a period of time during the year where you can change your mind and move from like an advantage plan over to a Medicare supplement. You can do make changes in your existing program. And we’re very, very fortunate today to have elder law attorney and special needs advocate — I always say he’s one of the best in the world — Mr Jim Koewler, from Ohio, the Cleveland, Ohio area, Richfield, Ohio actually. And Jim, welcome to the show.
Jim Koewler: Thanks Suzanne. Great to be here.
Suzanne: You’re a passionate advocate for our seniors. And first of all, for those are our listeners, Jim, you have lots of content on Answers for Elders and we’re very excited. You’re going to be coming out with your brand new podcast here very soon. So we’ll have more information on that. But I, you really spend a lot of time in advocating for those with special needs or seniors. And Medicare is one of those topics where we get so confused about and our government doesn’t do a very good job of educating consumers. We really don’t know what we’re signing up for. People don’t know that they’re supposed to enroll around their birthday when they turn 65. And so there’s a lot of questions. So I know you’re here to answer them. So welcome. So, tell us a little bit about what goes on this time of year.
Jim Koewler: Well, let’s back up to what happened at the end of last year, because that is really a lead in to what’s going on now. And from October 15 to December 7 of every calendar year, people on Medicare who are on Advantage plans and, or, well, Advantage plans are usually aren’t on a drug plan, but if they have some other form of insurance and they have a drug plan, they need to look at what they have, and sign up for what they want for the coming year. So in between October and December of 2022, people should have looked at their advantage plan to see if it was appropriate for them for the coming year ’23. And if they have a drug plan, a prescription plan, they should have looked at their drug plan to see if it was appropriate for them for ’23. So there’s some people who just let it ride, and that’s fine if it works for them, both prescription plans and advantage plans. There’s lots of shuffling into new Advantage plans and, and new prescription plans ,as there should be, because the prescriptions formularies change: the formula, the list of drugs they will cover, and at what rate, change every year, change every quarter. So, and that was locked down on Pearl Harbor Day, December 7. You were set on what you were getting for ’23.
OK, then ’23 starts, and a whole new period of it, is a carryover what they just signed up for. If you change your mind, you can change it again now, in ’23 for the rest of the year. So, and I will admit I’m using your terminology because I’m not 100% sure percent sure I’m keeping them straight, but the end of the year stuff, October to December is annual enrollment, and this January to March thing is open enrollment.
But neither of them allows you to jump into a Medicare Supplement, also called a Medicap plan. If you can’t qualify for it based on your health questions, they get to keep, not take you, if they don’t want to take the risk on you. So, there’s the move among Advantage Plans at these two times a year, plus there’s something more you can do. I’m guessing we’ll call, get to that later. If you’re not happy with your Advantage plan, you can jump one time per year to a five-star plan, if you’re not a five-star plan.
But a Medicap plan, a Medicare supplement, has to take you around your 65th birthday, and for the six months thereafter, or after you cease having employer coverage, and the six months after that. But once you get past those two time periods, they don’t have to take you, and open enrollment and annual enrollment do not change that.
Suzanne: Wow. We had a long conversation last week — for those of you who listened to the show — we talked about the Medicare Advantage program quite a bit. I know you’re not a fan of Medicare Advantage. But for certain people, it works depending on those that are low income and in marginalized areas that don’t have the resources to pay for the supplement. Tell us a little bit about it. Let’s say you’ve been on a Medicare Advantage plan. What happens if you want to upgrade to a Supplement? What is the process?
Jim Koewler: if you want to go to a Supplement after those initial time periods? Ok. Then you have to apply for a Medicare Supplement. The application will include some questions about your health. They may interview you, meaning come to your house, check you. And I’ve heard stories of people who have a cane in the corner, and it may have been great grandfather’s cane and it’s a collectible, but they got turned down because that created something in the mind of the underwriter. So they’re basically just checking to see if they’re willing to take the risk on your health, based on what you say in your answer to the questions on the application. And then if they choose to interview, what they see in meeting you, and what they see in your house, because they are not obligated to take a risk on you if you let the initial enrollment period go by without signing up for them.
Suzanne. Wow. Let’s say for example, somebody is low income and they’re on a Met Advantage program. All of a sudden their situation changes, maybe they have an h inheritance or they’re in a different financial position. What happens then, they still don’t have to take you. But is it a difficult process at that point?
Jim Koewler: It’s no, it’s a simple application. There are some insurance companies that last I knew you could apply online, significantly, and I think it’s still the case. You can do that with the United Healthcare Supplement available through aarp.com. But you can also get help from a broker to help you do these things. And then the brokers get paid something by the insurance company. Although there was a time when supplements didn’t pay brokers because supplements end up paying more in claims. So some brokers went to a placement fee which fans cannot do. But, frankly, I’m ok with that because, in my opinion, the Medicare supplement is so much better health coverage that it’s worth a placement fee and somewhere between $55, $100. I think that’s fair because it should, shouldn’t have to do it the next year because it’ll just carry over.
Suzanne: There’s differences between the Medicare Advantage and the Medicare Supplement. I want to go through that in our next segment and really define what that is. But in a nutshell, you help advise families. Ttell us a little bit about what you do specifically in this. You work with families on, on the insurance side?
Jim Koewler: A little, but it’s not what I do to get paid.
Suzanne: Got it. And so you are an elder law and special needs attorney. And Jim, you are located in Richfield, Ohio, but you serve all of the state of Ohio. Is that correct?
Jim Koewler: Again using lawyers words, yes and no. I do a little more than just the legal work, I work with care coordinators who look out after my client’s care and support services, make sure that my clients and I become our client. The care coordinators make sure our clients get the care that they’re supposed to get if they’re in a care situation, make sure they get the support services they’re supposed to get if they are in a support service situation, that tends to be special needs more than long term care. And while I can help clients with the legal work all over the state of Ohio, it’s not convenient for my three care coordinators to do that very, very far from their home bases. So, it’s easy for me to give the full range of my services with my care coordinators. They happen to be nurses, by the way.
Suzanne: Let’s talk about what you do because I want to do that in this next hour. And Jim you and I are gonna be right back right after this.
