Medicare, the federal health insurance program for people age 65 and older and younger adults with permanent disabilities, is an important source of health coverage for people with HIV. An estimated 120,000 Medicare beneficiaries are living with HIV. Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 to December 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.
Medicare and People Living with HIV
According to Medicare and HIV , a new issue brief from the Kaiser Family Foundation, as the size of U.S. population living with HIV has grown over time, due to an increased lifespan for people with HIV but also a steady number of new infections, so too has the number of Medicare beneficiaries with HIV. In fact, the program is now the single largest source of federal financing for HIV care and treatment with $10 billion spent on HIV/AIDS care in fiscal year 2016. And, a growing number of people living with HIV are “aging into” Medicare – becoming eligible beneficiaries because they are age 65 or older, not because of a permanent disability. This is most often the result of having had access to effective HIV treatment as younger adults, which means that more of those with HIV survive to older ages when they become entitled to Medicare.
As a result of changes in recent years, Medicare now also covers HIV testing as well as hepatitis B and hepatitis C screening, which can help beneficiaries with undiagnosed disease get connected to the care they need.
Medicare Open Enrollment: 5 Things You Need to Do
If you have a Medicare health or prescription drug plan – or if you are helping any individuals who do – Medicare Open Enrollment runs October 15 through December 7. It is the time Medicare enrollees (or “beneficiaries”) can make changes to your plan. Even if you’re happy with your current coverage, you might find something that’s a better fit for your budget or your health needs. If you miss an Open Enrollment deadline, you’ll most likely have to wait a full year before you can make changes to your plan.
Here are five important things every Medicare beneficiary can do to get in the Medicare Open Enrollment routine.
- Review your plan notice. Be sure to read any notices from your Medicare plan about changes for next year, especially your “Annual Notice of Change” letter. Look at your plan’s information to make sure your drugs are still covered and your doctors are still in network.
- Think about what matters most to you. Medicare health and drug plans change each year and so can your health needs. Do you need a new primary care doctor? Does your network include the specialist you want for an upcoming surgery? Is your new medication covered by your current plan? Does another plan offer the same value at a lower cost? Take stock of your health status and determine if you need to make a change.
- Find out if you qualify for help paying for your Medicare. Learn about programs in your state to help with the costs of Medicare premiums, your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) deductibles, coinsurance and copayments and Medicare prescription drug coverage costs. You can do this by visiting Medicare.gov or making an appointment with a local State Health Insurance Assistance Program (SHIP) counselor.
- Shop for plans that meet your needs and fit your budget. Starting in October, you can use Medicare’s plan finder tool at Medicare.gov/find-a-plan to see what other plans are offered in your area. A new plan may:
A. Cost less
B. Cover your drugs
C. Let you go to the providers you want, like your doctor or pharmacy
If you find that your current coverage still meets your needs, then you’re done. Remember, during Medicare Open Enrollment, you can decide to stay in Original Medicare or join a Medicare Advantage Plan. If you’re already in a Medicare Advantage Plan, you can switch back to Original Medicare.
- Check your plan’s star rating before you enroll. The Medicare Plan Finder has been updated with the 2016 Star Ratings for Medicare health and prescription drug plans. Plans are given an overall quality rating on a 1 to 5 star scale, with 1 star representing poor performance and 5 stars representing excellent performance. Use the Star Ratings to compare the quality of health and drug plans being offered.
These are a few easy ways to get a jumpstart on your Medicare Open Enrollment. For more information you can, call 1-800-MEDICARE (1-800-633-4227), and say “Agent.” TTY users should call 1-877-486-2048. Help is available 24 hours a day, including weekends. If you need help in a language other than English or Spanish, let the customer service representative know the language. You can also visit a local State Health Insurance Assistance Program (SHIP) counselor! SHIP counselors provide free, one-on-one, non-biased Medicare assistance. Get free personalized health insurance counseling by calling your SHIP. To get the phone number, visit Medicare.gov/contacts, or call 1-800-MEDICARE.