Free one-on-one counseling saved Delawareans $1.5M in 2022

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 2022, the team completed 5,123 counseling sessions, saving beneficiaries a combined $1.5 million.

When selecting 2024 coverage, there are important changes to keep in mind. Extra Help is expanding to offer full subsidy benefits to those up to 150% of the federal poverty level, allowing more people access to $0 premiums for coverage and fixed prescription copays. Additionally, those with Medicare Part D who fall into the catastrophic phase of their benefits will no longer have to pay 5% coinsurance for covered drugs during that period of coverage. And, on July 1, 2024, CMS will institute a new cap on Part B payment amounts for new biosimilars when average sales price data is not available.

2023 Medicare changes will continue into the new plan year. As of July 1, people with Traditional Medicare who take insulin through a traditional pump pay no more than $35 a month for their supply, and deductibles do not apply. Free vaccine coverage has expanded, and as of April 1 persons with Part B have lower coinsurance for drugs whose price increased faster than the rate of inflation.

“Delaware’s Medicare Assistance Bureau provides consumers with the education and empowerment they need to find the coverage they need at a cost they can afford,” said Insurance Commissioner Trinidad Navarro, who reminded residents to be smart shoppers this enrollment season.

“Part of being a smart shopper is knowing what to ask, and where to find trustworthy answers,” shared DMAB Director Lakia Turner. “There is no shortage of marketing during Open Enrollment, and bad actors may disguise themselves by offering information about changes for 2024. 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 17 to November 30:

• 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

Top Tips for a Successful Medicare Open Enrollment

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. DMAB has a Virtual Welcome to Medicare Seminar helpful for new and soon-to-be Medicare beneficiaries and those exploring enrollment changes.

The department does not manage benefits offered to state employees, pensioners, or spouses. While DMAB can counsel Medicare-eligible state plan members, questions about the state’s proposed Medicare Advantage plan or transition, they should first contact the Office of Pensions at 1 (800) 722-7300 and explore their online guide.

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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