Ashford Insurance

New Year, New Medicare Plan: What to expect after Open Enrollment

Picture of Sonia Ashford

Sonia Ashford

Sonia Ashford is the owner of Ashford Insurance, an independent health insurance agency specializing in Texas Medicare insurance.

Just enrolled in a new Medicare plan during Open Enrollment? Don't worry, this guide will help you navigate the initial steps and paperwork!

What to expect after Open Enrollment

First Steps:

  • Acknowledgement Packet: Within 10 days, you’ll receive an acknowledgement confirming your enrollment, effective January 1st. This acts as proof of coverage.
  • Member ID Card: Keep this safe! It’s your key to accessing prescriptions and healthcare services. Destroy your old card once your new coverage begins.

Important Documents:

  • Evidence of Coverage: This booklet details your plan’s benefits, limitations, cost-sharing amounts, appeal rights, and more. Keep it handy!
  • Drug Formulary: Check this list to see which medications your plan covers and any restrictions like prior authorization.
  • Pharmacy Network: Locate preferred and specialist pharmacies near you.
  • Provider Directory: Find in-network doctors, hospitals, and facilities, or request a printed copy.
  • Service Area: See which zip codes your plan covers.
  • Coordination of Benefits Form: Fill this out to avoid duplicate coverage issues.

Plan-Related Mail:

Open all plan mailings, even if they look like marketing. Some require action, like:

  • Drug coverage changes: You may have 60 days to switch medications if one gets removed.
  • Disenrollment notifications: Respond promptly to contest unfair termination.
  • Late enrollment penalties: Take action if you disagree with the assessment.
  • Annual Notice of Change (ANOC): Review cost and benefit changes for the upcoming year.
  • Plan closure notices: Act quickly if your plan is withdrawing service or going out of business.

Transition Drug Refills:

If your new plan doesn’t cover a medication you need, you may be eligible for a 30-day transition refill. Contact your plan for details.

Medicare Advantage Open Enrollment Period:

If you enrolled in a Medicare Advantage plan that doesn’t suit you, you can switch to a different one between January 1st and March 31st of the following year.

Remember, if you have any questions or concerns about your new plan, don’t hesitate to contact them directly. This guide is a starting point, but your plan can provide specific details and support.

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Picture of Sonia Ashford

Sonia Ashford

Sonia Ashford, “The Medicare Insurance Lady”, has been helping Medicare eligibles in Texas with their Medicare Insurance since 2005.