Medicare Assistance Bureau: Important Reminders Ahead of Open Enrollment

Free one-on-one counseling saved Delawareans $3.8M in 2023

As Medicare Open Enrollment approaches, the Delaware Department of Insurance and its Medicare Assistance Bureau (DMAB) are sharing their annual consumer information update. From October 15 to December 7, consumers can join, switch, or drop a Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan. DMAB’s free, confidential, unbiased one-on-one assistance can help residents determine if making a coverage change is the right choice. In 2023, the team completed 5,207 counseling sessions, saving beneficiaries a combined $3.8 million.

When selecting 2025 coverage, there are important new options and changes to keep in mind. The Medicare Prescription Payment Plan is a new payment option that works with a beneficiary’s current drug coverage to help manage out of-pocket Medicare Part D drug costs by spreading them across the calendar year. Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can voluntarily use this payment option. If this payment option is selected, consumers will continue to pay their plan premium (if they have one) each month and will get a bill from the health or drug plan to pay for the prescription drugs instead of paying the pharmacy. There’s no cost to participate in the Medicare Prescription Payment Plan.

Additionally, in 2025 Part D enrollees’ out-of-pocket drug costs will be capped at $2,000. This amount will be indexed to rise each year after 2025 at the rate of growth in per capita Part D costs.

While these federal changes are important to keep in mind during enrollment, the department also urges consumers to be aware of local changes. Particular attention should be paid to the consumers’ access to their preferred health providers.
“We have been made aware of a number of contracting changes between Delaware health systems and Medicare Advantage plans,” shared Insurance Commissioner Trinidad Navarro. “While we don’t have direct authority over these plans or their contracts, we are working with insurance regulators across the country to push the federal government to respond to increasingly frequent contract changes that can significantly impact consumers’ health care access.”

Commissioner Navarro and members of the National Associations of Insurance Commissioner requested that the Centers for Medicare and Medicaid Services (CMS) issue guidance on the matter and increase access to Special Election Periods (SEPs) to address such contracting changes.

The department and DMAB also urge residents to carefully assess contact received during the Open Enrollment window. “Educating and empowering Medicare beneficiaries about coverage, cost, and communications is a critical component of our work,” said DMAB Director Lakia Turner. “Marketing and solicitations rise dramatically in the fall months, so be wary of bad actors requesting your Medicare information, and look out for plans or promises that sound too good to be true. Our team can help you cut through the noise by answering your questions and identifying the best plan for your needs.”

In addition to scheduled phone and virtual appointments, DMAB is offering weekly appointments at all three Department of Insurance offices from October 22 to November 22:

• Tuesdays from 9:30AM-3:00PM at 503 Carr Road, Suite 303, Wilmington DE 19809
• Wednesdays from 9:30AM-3:00PM at 28 The Circle, Suite 1, Georgetown, DE 19947
• Thursdays from 9:00AM-3:30PM at 1351 West North St., Suite 101, Dover, DE 19904

1. Know that enrolling in a Medicare Advantage plan means it becomes your primary coverage. Original Medicare will no longer pay for services. You will receive a new ID card from the new plan, and should store your Original Medicare card in a safe place.
2. When moving from Original Medicare to a Medicare Advantage plan, be prepared to pay both a monthly Medicare Advantage premium and a monthly Medicare Part B premium.
3. Medicare Advantage plans do not automatically give you “more money in your Social Security check every month.” To qualify, you must be eligible for the Medicare Savings Program by having an income below Medicaid limits.
4. Check that additional benefits, like dental, vision, hearing, fitness, or over-the-counter medications are actually accessible if offered. Some network providers of these services may be farther away than anticipated, including in neighboring states, so only factor them into your decision if you feel they are usable.
5. Know that premium costs aren’t the only out-of-pocket costs you may face. Medicare Advantage plans may have co-pays or cost-sharing that differ from Original Medicare.
6. Call your preferred healthcare providers and facilities to understand if your prospective plan contracts with them. You may experience additional out-of-pocket expenses, service denial, or referral requirements if providers are considered out of network.
7. Check if a prospective plan is a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO). HMO plans require healthcare to be completed by a provider contracted with the plan’s network, otherwise the consumer will need a referral. PPO plans have both in-network and out of network providers and facilities, with consumer costs differing based on the network. HMO and PPO plans are not Medicare Supplement Plans, and may have out-of-pocket costs each visit.
8. Check if the plan provides Prescription Drug (Part D) coverage that meets your needs.
9. Be aware that in many cases, enrollment locks a person into a plan for the full upcoming calendar year.
10. Scrutinize any contact carefully during Medicare Open Enrollment to ensure it is from a known, credible source. Commercials, cold calls, and other contact may be scams or can provide deliberately misleading information about a plan.

About the Delaware Medicare Assistance Bureau

The Delaware Medicare Assistance Bureau provides free one-on-one health insurance counseling for people eligible for Medicare. Residents can call DMAB at 1 (800) 336-9500 or (302) 674-7364 to set up a free, confidential session or visit the DMAB website for important educational resources. Counselors can assist with Medicare, Medicare Advantage, Medigap (Medicare Supplement Insurance), long-term care insurance, billing issues, prescription savings, and much more.

Medicare Advantage plans are regulated at the federal level, though the Insurance Commissioner and his peers are advocating for increased state regulatory authority.

Be aware of non-compliant alternative health plans

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