Phil Castell
Castell Insurance
426 E. Washington St., Sequim, WA 98382
Phone: 360-683-9284 • Fax: 360-683-9026
Phil@CastellInsurance.com
www.CastellInsurance.com  

 

We are in the last few days of the Medicare Annual Election Period for 2013 benefits. For most folks the decisions have to be made by midnight on Friday, Dec. 7. The plan changes will all take effect on Jan. 1 and be in place for the year.

 

So, if you are reading this and still have not reviewed your options for 2013, you are not too late but the clock is definitely ticking.

 

If you have procrastinated until now, I am sure I shall be with you on Dec. 24 buying those Christmas gifts, as I also have a tendency toward procrastination.

 

At this late stage the two easiest methods to review your plans are to do it yourself on the www.Medicare.gov web-site or if you feel you would rather talk to a person, the wonderful folks at Medicare are there 24 hours a day and can be reached at 800-433-6227 or 800-MEDICARE.

 

Local help also is available but might be stretched a little thin on the ground. The local SHIBA office is at 411 W. Washington St. in Sequim, 452-3221, and some local insurance agents still will be available to assist you if you contact them.

 

If your plan worked great for you in 2012, it probably will do the same for you in 2013. However, I will now share with you a little tip that I was not aware of until recently.

 

If your current plan is going to remove a medication from the formulary that you take, by law they must notify you in writing that the medication would no longer be available under your current plan.

 

That should be a massive red flag that you need to review your coverage options.

 

These letters of formulary update can be sent throughout the year as changes occur, but the vast, vast number of changes take effect on Jan. 1 of each year.

 

If you know you received a letter or even think that you might have received a letter stating something like that, I would suggest you take no chances and review your plan.

Looking for loopholes

So, I have taken all this time and told you all about how this Friday is the deadline. As with nearly everything governmental there are loopholes and frequently even the loopholes have loopholes. Medicare is no different.

 

At this point I shall explain a couple of loopholes that might give you a little more breathing room.

If your current plan is no longer available next year, you are entitled to an SEP, otherwise known as a Special Election Period. This means that you may enroll anytime from Dec. 8 (when the AEP — Annual Election Period ends) through Feb. 28 of the following year.

 

So, if you were covered under the Group Health Options Elite program that is withdrawn for 2013 and have not yet made a decision, you can relax slightly. This also applies to a couple of Part D Rx plans that likewise are no longer available for 2013.

 

However, if you would like coverage to be in place for Jan. 1, you still should be making a choice fairly soon.

 

If you wait until January to choose a plan, you will be fine and the coverage would take effect on Feb. 1. That would mean that you would be on traditional Medicare for the month of January and not have any prescription drug coverage for that month.

 

If you procrastinated until February, the coverage would likewise take effect on March 1.

 

Even if you did wait until the very last minute, you would not be facing any of those Part D penalties you have heard so much about, as the rules state that you must go more than 63 days without coverage before penalties would be assessed.

 

Another segment of the population who are not affected by the penalties and in fact have a 12-month SEP are those who are currently receiving a low-income subsidy.

 

I see many people who consider themselves to be low-income, but the income threshold to be low-income is low. I do, however, strongly advise folks who think they might be low-income to contact the Social Security office either in Port Angeles or toll free at 800-772-1213.

 

If they do in fact qualify, the premiums and co-pays are greatly reduced or eliminated completely depending upon their situation.

 

In closing I would just like to say: It has been real and it has been fun and for the most part it has been real fun. Merry Christmas and Happy New Year and please stop in to say “Hi” as you are out and about over the holidays.

 

Phil Castell is an independent insurance agent in Sequim. He can be reached at 683-9284 or PhilCastell@msn.com.