Medicare’s Fall Open Enrollment Period is Under Way!
Medicare’s Annual Open Enrollment Period started October 15th and will run through December 7th. During this period, all Medicare beneficiaries can make changes to their health or drug plan coverage. Changes made during this period start January 1, 2022.
Everyone with Medicare is encouraged to review their current plan’s coverage for next year to see if it will still meet their needs. PA MEDI staff and volunteers can help people across Pennsylvania review their 2022 Medicare coverage options. Medicare beneficiaries who need help reviewing their plan options for next year are encouraged to call PA MEDI’s statewide helpline at 1-800-783-7067 to connect with their local program.
Details about 2022 Medicare plan offerings
Stand-Alone Prescription Drug Plans: There are 25 stand-alone prescription drug plans available across Pennsylvania for enrollment in 2022. Premiums for these plans range from $7.20 to $178.30 per month. Next year, there are seven “zero-premium” plans for individuals who qualify for full Extra Help (click here for the 2022 list). All seven plans are also zero-premium plans in 2021. There are three zero-premium plans that were offered in 2021 that will not be offered next year. Express Scripts merged with Cigna so individuals enrolled in the Express Scripts Medicare-Value plan will be moved to the Cigna Secure Rx plan next year. The Indy Health SaverRx and the Wellcare Medicare Rx Saver plans will no longer be offered in 2022 and people in these plans will be moved to a different zero-premium plan unless they make a plan choice on their own.
Medicare Advantage Plans: Residents in every county in Pennsylvania continue to have many Medicare Advantage plans to choose from. Lebanon County has the most Medicare Advantage plans (74) and Pike County has the fewest (24). These numbers do not include Medicare Special Needs Plans that limit their enrollment to certain groups of Medicare beneficiaries: dual eligibles, people in nursing homes, and people with certain chronic conditions.
Most, but not all, of the Medicare Advantage plans available include drug coverage. Individuals considering a Medicare Advantage plan for 2022 should check the plan’s costs, benefits, provider network and pharmacy network, list of covered drugs, and any extra benefits offered, such as dental or vision care or Special Supplemental Benefits for the Chronically Ill (SSBCI). It’s important to note that the SSBCI benefits are not guaranteed, and people will only learn if they are eligible for SSBCI benefits after they enroll in the plan. More details about plan offerings and plan benefits can be found on www.medicare.gov.
Special Needs Plans for Dual Eligibles (D-SNPs): These plans only enroll Medicare beneficiaries who also have Medicaid – people who fall into this group are called dual eligibles. Click here for the listing of D-SNPs by county for 2022.
It is important to remember that the D-SNP only provides the member with their Medicare coverage and the person still has Medicaid as a separate insurance coverage that often pays second. In 2022, all counties in Pennsylvania will have at least three D-SNPs available. Most counties have nine or more D-SNPs available. Most D-SNPs require that someone have full Medicaid in order to enroll, but some of the plans do allow people to enroll if the only benefit they get from Medicaid is payment of the Medicare Part B premium. People with this limited help from Medicaid are known as “partial dual eligibles.”
Notable changes about Pennsylvania D-SNP options for 2022 are:
- Gateway Health Medicare Assured Diamond and Ruby plans will be called Highmark Wholecare Medicare Assured Diamond and Ruby;
- UnitedHealthcare has added a second D-SNP offering, called UnitedHealthcare Dual Complete Select, that will allow partial dual eligibles to enroll;
- Cigna added a second D-SNP offering, called Cigna TotalCare Plus, that will allow certain partial dual eligibles to enroll;
- Allwell Dual Medicare will be called Wellcare Dual Access; and
- Aetna Medicare Advantra Cares and Highmark Wholecare (former Gateway Health) have expanded into more counties.
- As in 2021, the three D-SNPs that are aligned with Community HealthChoices plans are not all offered as an option in three counties in Pennsylvania in 2022. UPMC’s D-SNP (UPMC for Life Complete Care) will not be offered in Columbia or Northumberland counties. Pennsylvania Health and Wellness’ aligned D-SNP (called Allwell Dual Medicare in 2021 and Wellcare Dual Access in 2022) will not be offered in Columbia, Montour, or Northumberland counties.
Other 2022 Updates and Reminders
Medicare Plan Finder
People can visit www.medicare.gov to get details about health and drug plans available in Pennsylvania next year. Medicare beneficiaries need to create an account on the medicare.gov website to save their drug lists or save plan searches. No email address is required to create an account.
Medicare beneficiaries should beware high pressure sales tactics or aggressive marketing during the open enrollment period. Agents and brokers selling Medicare Advantage and Part D prescription drug plans may not market to beneficiaries door to door, including leaving materials at a beneficiary’s doorstep. They also may not make unsolicited calls or send unsolicited text messages to Medicare beneficiaries, or approach beneficiaries unsolicited. Anyone with concerns about Medicare marketing, fraud, abuse, or scams can call Pennsylvania’s Senior Medicare Patrol program at 1-800-356-3606.
Watch out for Extra Help Mailings to Medicare Beneficiaries
The Center for Medicare & Medicaid Services (CMS) sends several mailings each Fall related to Extra Help. Notices are sent when someone’s automatic Extra Help will end this year, when their copay amounts are changing next year, and when someone needs to complete a redetermination form to determine if they will qualify for Extra Help again next year.
- Loss of deemed status letter (grey): Mailed in September to those who no longer automatically qualify for Extra Help in 2022. This happens when someone lost Medicaid coverage or help with the Medicare Part B premium between July 2020 and June 2021 and has not requalified for that assistance. Because of protections in place since March 2020 due to the COVID-19 federal public health emergency declaration, most people should not have lost Medicaid this year. Unless someone voluntarily ended their Medicaid coverage or help with the Medicare Part B premium, people should generally not be receiving these grey letters this year.
- Extra Help redetermination form from SSA: Every year, Social Security chooses a certain number of people to review for continued Extra Help eligibility. Redetermination paperwork is sent in September and must be completed and returned. If the renewal is not completed, Extra Help will end in 2021.
- Extra Help Copay Changes: In October, Medicare notifies people who automatically get the Extra Help but whose copay levels are changing next year. This notice is sent on orange paper.
Find more information about mailings to Medicare beneficiaries here.
Dual Eligibles and People with Extra Help Who Want to Change Plans for 2022 Must Act By December 7th!
People can pick a new plan to start January 1, 2022; however, they must choose the new plan before December 7, 2021. As a reminder, dual eligibles and others with Extra Help are limited to changing their Medicare health or drug plan once per quarter during the first three quarters of the year. Now that we are in the final quarter of the year, people generally cannot make any changes to their Medicare coverage for this year.
Next year, people with Extra Help can change their plan once per quarter between January 1st and September 30th. The request to change plans becomes effective the next calendar month. For example, if a dual eligible beneficiary with Original Medicare made an election to change her Part D plan in April, the change would go into effect May 1st, and she would not be able to make another plan change until the next quarter - July-September. During the last quarter of the calendar year (October-December), dual eligibles and those with Extra Help can use the annual open enrollment period from October 15th-December 7th to make changes to their coverage, with the new plan starting January 1st.