Where can I get help with my questions about Medicare?
The Department’s Senior Health Insurance Benefits Advisors (SHIBA) office provides free and unbiased information, counseling
and assistance for people with Medicare to help them with their Medicare questions.
I have Medicare Part D (Rx coverage) and am afraid I'll hit the coverage gap this year. Can I get help?
The health care reform law will gradually eliminate the coverage gap, or “donut hole.” By 2020, you will pay only 25% for
prescription drugs during the coverage gap, the same percentage you pay from the time you meet the deductible. The table below
shows how your cost for prescriptions will decrease between now and 2020.
||Your cost for
in the coverage gap
||Your cost for
in the coverage gap
Medicare’s Preventive Services
As of Jan. 1, 2011, proven preventive services, such as mammograms or colonoscopies, are free. Also, Medicare will provide a new
annual wellness visit that includes a health risk assessment.
Medicare Supplements for people under 65
- A beneficiary is under 65 and currently has a Medigap policy. Will the changes in Rule 54 regarding pricing result in them possibly receiving a premium decrease? For example, if their plan premium is more than 150% of the age 65 premium.
- Yes, under Rule 54, a pre-65 individual with a current Medicare Supplement policy would receive a premium change upon renewal after 1/1/2018 to no more than 150% the Age 65 rate.
- A beneficiary is under 65 and through the rule change is able to purchase a Medigap after January 1, 2018. When the beneficiary turns 65, do they again have an open enrollment into a Medigap?
- Yes, the rule gives pre-65 eligible individuals both an open enrollment when first eligible and again at age 65. This would allow them to switch issuers or stay with the same carrier. Even if they don’t use the age 65 open enrollment period, the issuer must charge them the age 65 rate once the individual reaches that age.
- A beneficiary receives retroactive eligibility from Social Security Administration (SSA), before 1/1/18. Do they have a guaranteed issue?
- Any pre-65s with retroactive eligibility prior to 1/1/18 will have the 6 month period starting 1/1/18 as their Open Enrollment window.
- If a person under 65 has a supplement now, will they get an open enrollment 1/1/18 to look at a new supplement without medical underwriting?
- A beneficiary is under 65 and enrolled in a Medicare Advantage Plan. They enrolled in the plan when they first became eligible for Medicare, less than 12 months ago. The beneficiary is now interested in a Medicare Supplement plan. Does the beneficiary have a trial right to purchase a Medigap? If so, which companies can they purchase from?
- Yes, the person is eligible for guaranteed issue. They may purchase a plan without underwriting from companies already selling plans to people under 65. Beginning 1/1/18, they would have six months to purchase a plan from any company offering Medicare Supplement policies.
Return to SHIBA Home
Contact us for answers to your Medicare questions. Call SHIBA: 1-800-247-4422|
SHIBA is a program provided by the Idaho Department of Insurance with financial assistance through a grant from the
Administration for Community Living (ACL). SHIBA is Idaho’s State Health Insurance Assistance Programs (SHIP), a program that helps
states enhance and support a network of local staff and volunteers to assist people with Medicare.