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

Free one-on-one counseling saved consumers more than a half million dollars in 2021

As the October 15 to December 7 Medicare Open Enrollment quickly approaches, the Delaware Department of Insurance and its Medicare Assistance Bureau (DMAB) are sharing their annual consumer information announcement.

During Medicare Open Enrollment, 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 2021, DMAB provided more than 5,500 counseling sessions, saving beneficiaries a combined $521,000.

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 Medicare Advantage plan or transition should first contact the Office of Pensions at 1 (800) 722-7300 and explore their online guide. Medicare Advantage plans themselves are regulated at the federal level, though the Insurance Commissioner and his peers are advocating for increased state regulatory authority.

“Our Medicare Assistance Bureau is an important resource for residents. Many Delawareans face confusion when it comes to Medicare Advantage plans, and as Open Enrollment approaches, they will begin to see an influx of television commercials and be targeted by a lot of other enrollment marketing,” said Insurance Commissioner Trinidad Navarro.

DMAB Director Lakia Turner agreed. “Many beneficiaries enroll in plans based on marketing, without fully assessing the plan’s total costs or asking key questions about their coverage, and ultimately that means they then experience unexpected issues. We work hard to inform consumers on the front-end to help ensure they get the right plan from the start.” Commissioner Navarro and Director Turner recently shared enrollment advice on Delmarva Life.

Ten 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.

Be aware of non-compliant alternative health plans

“I applaud the U.S. Senate for reaching an agreement to raise the nation’s debt limit. While not everyone understands exactly what that means, just about all of us will benefit from the decision. Raising the debt limit allows the country to basically “pay its bills.” It doesn’t open the door for additional spending, it enables us to borrow what we need to pay for expenses we’ve already incurred.

We’ve heard a lot about the impact on Social Security and veteran’s benefits had this agreement not been reached, but the impact would have been felt by most everyone across Delaware and the country. Federal dollars help sustain many essential programs on the state level; Medicaid and the Children’s Health Insurance Program, special education, programs providing free or reduced-cost school meals for low-income students, the list goes on and on.

For the sake of all Delawareans, I thank our leaders for stepping up to help protect the services that are so essential to our citizens and our economy and look forward to passage in the U.S. House of Representatives.”

Free one-on-one counseling and information available to residents; Bureau earns federal grant

The Delaware Medicare Assistance Bureau (DMAB), a division of the Delaware Department of Insurance, is encouraging residents to get ready for Medicare Open Enrollment. DMAB, which provides free, one-on-one Medicare counseling, offers a myriad of virtual appointment options for residents, as well as video tutorials and other guides that can assist in beneficiaries’ preparation. DMAB has provided more than 3,000 counseling sessions so far this year, saving beneficiaries more than $372,438 in premiums through application help.

DMAB will engage in thousands of counseling sessions during Medicare Open Enrollment, which takes place October 15 through December 7. During this time, beneficiaries can make changes to their health and drug coverage and review existing coverage against other options. DMAB will offer virtual appointments throughout this period, available via Webex, Duo, and Microsoft Teams, as well as by phone. Residents are encouraged to register for a MyMedicare.gov account prior to their counseling session so that DMAB can generate personalized plan comparisons.

“Our DMAB team works to increase residents’ understanding of the complex Medicare system and can even help save you money. I encourage the community to reach out to our team for Medicare assistance and information,” said Insurance Commissioner Trinidad Navarro.

A Virtual Medicare Seminar, which DMAB began to offer in 2020, is available on-demand online, and educates participants on topics including Medicare benefits, supplemental insurance policies, Medicare Advantage plans, prescription drug coverage and details on signing up. While specifically created for new or soon-to-be eligible beneficiaries, the informative series can be helpful for all Medicare participants.

“Many people have questions about Medicare and don’t know where to start, and COVID-19 has only increased the stress of choosing the right healthcare plans. We are here to help people in Delaware deal with the complex and often confusing health insurance system,” said DMAB Director Lakia Turner, “and, we’re more accessible than ever through our new virtual programs.”

As Medicare Open Enrollment approaches, the Department of Insurance reminds residents to scrutinize any contact during the open enrollment period to ensure it is from a known, credible source. The most frequent fraudulent contact occurs by phone, but residents should review all communications carefully.

“If you are receiving contact regarding Medicare that you did not initiate, or contact not from one of your healthcare providers, it could be fraudulent,” said Commissioner Navarro. “Protect your Medicare Number like you do your Social Security number or bank account information, and never give it out to unknown or unexpected callers.”

DMAB has been awarded a Medicare Improvement for Patients and Providers Act (MIPPA) 2021 Grant from the federal government, which will provide the bureau $71,943. The annual MIPPA grant has and will assist the bureau’s outreach, education, and one-on-one beneficiary assistance programs over the next year by assisting those beneficiaries who are likely to be eligible for the Low-Income Subsidy program (also called “Extra Help”) or Medicare Savings Programs.

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. Counselors can assist with Medicare, Medicaid, Medigap (Medicare supplement insurance), long term care insurance, billing issues, prescription savings, and much more.

 View DMAB’s 2021 Open Enrollment Flyer

NEW CASTLE (March 26, 2021) – The Department of Health and Social Services (DHSS) has updated its guidance to Delaware’s long-term care facilities following recent federal recommendations that allow for expanded indoor visitation during the COVID-19 pandemic.

The guidance was updated last week and was sent to the state’s 86 long-term care (LTC) facilities; it can be found here. The updated guidelines follow the release earlier this month of revised visitation recommendations by the Centers for Medicare & Medicaid Services in response to reductions in COVID-19 infections and transmission and increased vaccination rates in the nursing home population.

“As COVID-19 cases and hospitalizations decrease in Delaware and our vaccinations increase, we know that families and close friends of residents of nursing homes and assisted-living facilities are eager to have in-person indoor visitation with their loved ones once again,” DHSS Secretary Molly Magarik said. “We are pleased that our Division of Health Care Quality and Division of Public Health have come up with a reopening and visitation plan that supports long-term care facilities in making that happen.”

Highlights of the guidance include:

Indoor visitation

• LTC facilities should allow and support indoor visitation for all residents regardless of vaccination status, with certain exceptions when visitation should be limited for the following residents because of a high risk of COVID-19 transmission:
  • Unvaccinated residents, if the nursing home’s COVID-19 county positivity rate is greater than 10 percent and fewer than 70 percent of residents in the facility are fully vaccinated;
  • Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue transmission-based precautions;
  • Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.

• LTC facilities should use the COVID-19 county positivity rate as additional information to determine how to facilitate indoor visitation.
• LTC facilities should consider how the number of visitors per resident at one time and the total number of visitors in the facility at one time (based on the size of the building and physical space) will affect the ability to maintain the core principles of infection prevention consistent with CDC guidance. If necessary, facilities should consider scheduling visits for a specified length of time to help ensure all residents are able to receive visitors.
• Visitors should go directly to the resident’s room or designated visitation area, and visitor movement in the LTC facility should be limited.
• Visits for residents who share a room should not be conducted in the resident’s room, if possible. For situations where there is a roommate and the health status of the resident prevents leaving the room, facilities should attempt to enable in-room visitation while adhering to the core principles of COVID-19 infection prevention.
• If a resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after. Regardless, visitors must physically distance from other residents and staff in the facility.

Required visitation

• An LTC facility may not restrict visitation without a reasonable clinical or safety cause, consistent with federal and state regulations regarding rates of COVID-19 positivity in the county and the facility, and the rate of immunization among residents.
• Residents who are on transmission-based precautions for COVID-19 should only receive visits that are virtual, through windows, or in-person for compassionate care situations, with adherence to transmission-based precautions.

Outdoor visitation

• Outdoor visits are preferred even when the resident and visitor are fully vaccinated against COVID-19. Visits should be held outdoors whenever practicable.
• Aside from weather considerations or an individual’s health status, outdoor visitation should be routinely facilitated.
• LTC facilities should have a process to limit the number and size of visits simultaneously to support safe infection prevention practices.

Compassionate Care Visits

• Compassionate care visits should be allowed at all times regardless of a resident’s vaccination status, the county’s positivity rate, or an outbreak.
• The term “compassionate care visit” does not exclusively refer to end-of-life situations. Examples of other types of compassionate care situations include, but are not limited to:
  • A resident, who was living with their family before recently being admitted to a LTC facility, is struggling with the change in environment and lack of physical family support.
  • A resident who is grieving after a friend or family member recently passed away.
  • A resident who needs cueing and encouragement with eating or drinking, previously provided by family and/or caregiver(s), is experiencing weight loss or dehydration.
  • A resident, who used to talk and interact with others, is experiencing emotional distress, seldom speaking, or crying more frequently (when the resident had rarely cried in the past).
• In addition to family members, compassionate care visits can be conducted by any individual that can meet the resident’s needs, such as clergy or lay persons offering religious and spiritual support.
• Compassionate care visits should be conducted using social distancing; however, if a visitor and facility identify a way to allow for personal contact, it should only be done following all appropriate infection prevention guidelines, and for a limited amount of time.
• Fully vaccinated residents can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after.
• Visitors must physically distance from other residents and staff.
• LTC facilities should work with residents, families, resident representatives, and the state’s Long Term Care Ombudsman program through a person-centered approach, to identify the need for compassionate care visits.

Visitor Testing and Vaccinations

• Visitors should not be required to be tested or vaccinated (or show proof of such) as a condition of visitation.
• Although not required, facilities in medium- or high-positivity counties are encouraged to offer testing to visitors, if feasible.
• Facilities may encourage visitors to be tested on their own prior to coming to the facility (e.g., within 2–3 days).

The updated plan also includes sections on communal dining and activities and on indoor visitations during a COVID-19 outbreak. The state defines an outbreak as a single new COVID-19 infection in a facility staff or any LTC facility onset COVID-19 infection in a resident. A resident admitted to the facility with COVID-19 does not constitute a facility outbreak.

If members of the public find the visitation is not occurring as per the guidance, complaints can be filed with the Division of Health Care Quality:

• Phone: 1-877-453-0012
• Fax: 1-877-264-8516
• Online: https://dhss.delaware.gov/dhss/dhcq/mailform.html

To protect residents and staff, visitation was discontinued at Delaware’s long-term care facilities beginning in mid-March 2020, when the state’s first positive COVID-19 case was announced. Starting in June 2020, when positive COVID-19 cases and hospitalizations had declined in Delaware, eligible nursing homes and assisted-living facilities were able to submit plans for outdoor visitation. And in September 2020, eligible facilities could submit plans to resume indoor visitation. With the COVID-19 surge that began in December 2020, visitation was once again restricted until the end of February 2021.