Congratulations to Ms. Dee Ductible and her friend Benny Fit for completing open enrollment! They received a lot of information and ask what’s most important to read. Where do they start?
Three useful publications are:
Certificate of Coverage, or COC (available from your health plans)
This publication, also known as the Evidence of Coverage (EOC), is produced each year by your health plan(s) to provide detailed information about the plan’s benefits and what is and is not covered. Examples include finding a health care provider, what you pay, summary of services and how to appeal a denial. It is highly recommended that you call your plan for a copy or view it online.
Formulary (available from your plan or at Medicare.gov)
Most Medicare drug plans (Medicare Part D drug plans and Medicare Advantage plans with prescription drug coverage) have their own unique list of what drugs are covered, called a formulary. Plans include both brand-name prescription drugs and generic drug coverage. The formulary includes at least 2 drugs in the most commonly prescribed categories and classes. This helps make sure that people with different medical conditions can get the prescription drugs they need. Note that a formulary can change anytime during the year. If you ever want to change prescription drug plans it is very important that you check to make sure that the new plan covers the drugs that you currently take. Otherwise you run the risk of paying more, often significantly more, with the new plan.
Medicare & You (the Medicare Handbook you receive every year)
The “Medicare & You” handbook is your official guide to Medicare. Medicare mails a printed copy to all Medicare households in late September, unless you have elected to receive the handbook electronically. If so, you will receive an email annually with a link to the electronic version of the handbook, which will have the most up-to-date Medicare information faster. (You can change your preference at any time by logging into your account at: https://www.medicare.gov/account/login)
The handbook is available in many different formats and languages, including large print, braille and more.
- Keep your handbook as a reference. It has very important information about: Medicare benefits, costs, rights, and protections
- Health and drug plans
- Answers to common questions
Remember that health care insurance is confusing for almost everyone. That’s not your fault. Fortunately, there are impartial experts to help you from SHIBA, operated by the WA Office of the Insurance Commissioner. Call (1-800-633-4227) for help with marketplace and /commercial health plans, as well as group plans such as PEBB and Boeing.