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January 1st to March 31st is the Medicare Advantage Open Enrollment Period, previously known as the Disenrollment Period.

Open Enrollment Period MA or MAPD enrollees have the option to:

  • Switch to another Medicare Advantage plan (with or without drug coverage). 
  • Return to Original Medicare (Part A and Part B) and, if desired, enroll in a Medicare Part D prescription drug plan

This period allows your clients to make changes to their Medicare Advantage coverage, but they cannot enroll in a Medicare Advantage plan for the first time during this period. For first-time enrollment, they would need to use the Annual Enrollment Period (October 15 to December 7) or their Initial Enrollment Period.

During the OEP, do not:

  • Send beneficiaries unsolicited communications about the ability to make any additional changes or reference the MA OEP.
  • Target, by way of purchased mailing list or any other means, any beneficiary who’s in the MA OEP because they made a decision during AEP.
  • Participate in or advertise any agent/broker activities that address the MA OEP as a means of making more sales.
  • Contact former enrollees who chose a new plan during AEP.
  • Use the MA OEP as an excuse to reach more clients you didn’t get to see during AEP.

For more detailed information, click the button below to download our flyer outlining the important aspects of the Medicare Advantage Open Enrollment Period.

Download the OEP Flyer

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In Pennsylvania, PACE (Pharmaceutical Assistance Contract for the Elderly) and Extra Help are not the same, but they both aim to assist with prescription drug costs.

PACE is a state program that helps qualified residents aged 65 and older get prescription medications at a lower cost. It works with Medicare Part D and other prescription drug plans to reduce out-of-pocket expenses.

When you are enrolled in PACE/PACENET and have a Medicare Part D plan that is not partnered with PACE/PACENET, there are a few key points to keep in mind:

  1. Premium Payments: You will need to pay your Medicare Part D premium directly to your insurance provider. PACE/PACENET will not cover this premium 
  2. Prescription Costs: At the pharmacy, you will still benefit from PACE/PACENET's assistance with prescription costs. Your pharmacist will bill your Medicare Part D plan first and then PACE/PACENET for any remaining costs, ensuring you pay the lowest possible amount
  3. Deductibles: The program also helps with deductibles. If you qualify for PACE/PACENET, you may not have to pay the annual deductible for your Part D plan
  4. Formulary Differences: If your Medicare Part D plan does not cover certain medications that PACE/PACENET does, PACENET will either cover those medications or work with your Part D plan to get them covered
  5. No Late Enrollment Penalty: If you qualify for PACE/PACENET, you won't have to pay a late enrollment penalty. This assistance ensures that you won't have to bear the additional cost of the penalty if you enroll in PACE. 

Extra Help, also known as the Low-Income Subsidy (LIS), is a federal program that helps people with limited income and resources pay for Medicare prescription drug plan costs, such as premiums, deductibles, and co-payments.

Here's how it works with a Part D plan:

During the OEP, do not:

  1. Premiums: Extra Help can cover all or part of your Medicare Part D plan's monthly premium. This means you may pay a reduced premium or none at all, depending on your level of Extra Help
  2. Deductibles: The program also helps with deductibles. If you qualify for Extra Help, you may not have to pay the annual deductible for your Part D plan
  3. Co-payments and Coinsurance: Extra Help significantly reduces the cost of prescription drugs. You will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug in 2024
  4. Coverage Gap: Extra Help eliminates the coverage gap (often referred to as the "donut hole") in Medicare Part D, ensuring continuous coverage for your prescription medications
  5. No Late Enrollment Penalty: If you qualify for Extra Help, you won't have to pay a late enrollment penalty if you join a Medicare drug plan after your initial enrollment period 

While both programs provide financial assistance for prescription drugs, PACE is specific to Pennsylvania residents and has different eligibility criteria compared to the federal Extra Help program.

How to apply for PACE: https://pacecares.primetherapeutics.com/Enrollment.html 

How to apply for Extra Help: https://www.ssa.gov/medicare/part-d-extra-help

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There is a lot of confusion around what you can use your Health Savings Account (HSA) money for, especially after leaving a job. That may be because it works differently depending on the coverage that you have, group, COBRA, Pennie, or Medicare. We know you can use it for medical expenses, however we often get the question if that includes your monthly premium.

Insurance premiums

You can’t treat insurance premiums as qualified medical expenses unless the premiums are for any of the following:

  • Long-term care insurance. The premiums for long-term care insurance that you can treat as qualified medical expenses are subject to limits based on age and are adjusted annually. See Limit on long-term care premiums you can deduct in the Instructions for Schedule A (Form 1040).

  • Health care continuation coverage (such as coverage under COBRA). Can be for your spouse or a dependent meeting the requirement for that type of coverage.

  • Health care coverage while receiving unemployment compensation under federal or state law. Can be for your spouse or a dependent meeting the requirement for that type of coverage.

  • Medicare and other health care coverage if you were 65 or older (other than premiums for a Medicare supplemental policy, such as Medigap). If you, the account beneficiary, aren’t 65 or older, Medicare premiums for coverage of your spouse or a dependent (who is 65 or older) aren’t generally qualified medical expenses.

Health coverage tax credit

You can’t claim this credit for premiums that you pay with a tax-free distribution from your HSA. See Pub. 502 for more information on this credit.

Learn more: https://www.irs.gov/publications/p969#en_US_2023_publink1000204086

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