west virginia watch

BY: LORI KERSEY – OCTOBER 24, 2023 6:00 AM

Beginning this month, Medicare beneficiaries can review and change their health insurance coverage for the upcoming year. 

Open enrollment for the federal health insurance program began Oct. 15 and continues through Dec. 7. Coverage changes made during open enrollment take effect Jan. 1. 

“This is the main time that people can change their insurance If they determine that there might be another plan that would be a better fit for them,” said Rebecca Gouty, the state director of the State Health Insurance Assistance Program. The SHIP program, which is federally funded by the U.S. Administration for Community Living, offers information, counseling and assistance for beneficiaries.

“It’s also the time for people who don’t have coverage, maybe they didn’t sign up for prescription coverage or a Medicare Advantage plan when they were first eligible, or they lost that coverage for some reason and they want to get that coverage back for the next year, this is that timeframe to do it,” she said.

People who don’t wish to change their coverage do not need to re-enroll. 

In West Virginia, 445,835 people are enrolled in Medicare, according to the federal Centers for Medicaid and Medicare Services. The program is available to people over age 65, those on Social Security Disability, and people with end-stage renal disease. 

Medicare plan premiums, co-pays and covered benefits can change a lot from year to year, Gouty said. People who don’t review their plan and make changes during the open enrollment period, may be locked into a plan that’s not a good fit for them, she said. 

According to the federal Centers for Medicare and Medicare, the average monthly Medicare Advantage plan premium in West Virginia changed from $20.36 in 2023 to $20.90 in 2024. Fifty-eight Medicare Advantage plans are available to West Virginians in 2024, compared to 53 plans in 2023. In addition, West Virginians have access to 21 stand-alone Medicare prescription drug plans in 2024. 

Beginning in 2023, the Inflation Reduction Act capped the cost of insulin for Medicare drug coverage beneficiaries at $35 per month, and covered vaccines at no cost.

In 2024, through the Inflation Reduction Act, people with Medicare prescription drug coverage who fall into the catastrophic phase of the benefit will pay nothing out of pocket during that phase for covered Medicare prescription drugs, Gouty said.

Also next year, the Extra Help program, a low-income subsidy for prescription costs available to those who make up to 150% of the federal poverty line, will have expanded eligibility for full benefits.

“In 2024, anybody up to 150% of the federal poverty level, as well as meeting the asset guidelines, will have what’s called full Extra Help, which means that in 2024, they will pay no more than $4.50 for generic and $11.20 for name brand medicine as long as they are on the plan formulary,” Gouty said. 

In 2025, out-of-pocket costs for prescriptions will be capped at $2,000. 

Gouty said people should be aware of the potential for scams related to Medicare open enrollment. Medicare will never call people, so if a caller says they’re with Medicare, hang up the phone, she said. 

“Medicare does not send out new Medicare cards annually,” she said. “If you get a phone call asking if you have received your new Medicare card for 2024, or asking if saying that the Medicare card has been redesigned to be plastic, gold, or have a chip embedded in it — these are all scams, hang up the phone.”

Also, don’t give out a Medicare number to unsolicited callers, she said.

To review plans, beneficiaries can visit Medicare.gov. Assistance is available by calling 1-800-MEDICARE or through the West Virginia SHIP office by calling 877-987-4463. Visit Shiphelp.org to find a local office anywhere in the country. 

** West Virginia Watch is a nonprofit media source. Articles are shared under creative commons license. Please visit https://westvirginiawatch.com/ for more independent Mountain State news coverage.

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