Medicare Coverage Choices

There are two (2) main ways to get Your Medicare Coverage:

• Original Medicare (Part A, Part B, Medigap/Supplemental & Part D)
• Medicare Advantage Plan (Part C)

Medicare Advantage plans may change their provider network at any time but must provide CMS with a 90 day notice prior to making this change. This could affect an Alpha’s augmentation therapy infusions and other essential coverage. For more information, visit:

• Medicare.gov
• Medicare Advantage Plans
• 14 things to know about Medicare Advantage Plans

Medicare Open Enrollment is the one time of year when anyone who has a Medicare policy can make changes to their health and prescription drug plans for the next year. For people with Alpha-1, this is your opportunity to be sure your Alpha-1 augmentation therapy will be covered in 2022.

For 2023 coverage, please check back here for the dates, which will be posted here once they are released. During the annual enrollment period (AEP) you can make changes to various aspects of your coverage. You can switch from Original Medicare to Medicare Advantage, or vice versa.

Helpful Resources and Videos:

1. Understanding Your Medicare Choices
2. Medicare and You: Open Enrollment
3. Medicare and You: Different Parts of Medicare
4. Use the Online Medicare Plan D Finder (compile a list of all your prescribed medications and dosages)
5. Medicare Quick Check Plan D Finder PDF
6. Social Security, SSI and Medicare (includes ASL for hearing impaired)

For personalized assistance:

1. Medicare toll-free number: 1-800-MEDICARE (633-4227)
2. State Health Insurance Counseling and Assistance Programs (SHIPs)
3. For Access to Care or Reimbursement issues and general questions regarding private insurance or Medicare, contact Cathey Henderson at (877) 346-3212, Director of Community Programs, or by email at chenderson@alpha1.org.

The 2019 Open Enrollment Period runs from Thursday, November 1, 2019, to Saturday, December 15, 2019. If you don’t act by December 15, you can’t get 2019 coverage unless you qualify for a Special Enrollment Period. Plans sold during Open Enrollment start January 1, 2019.

• See Your State’s Insurance Marketplace from NORD.
• Download the ‘How to Choose an Insurance Plan’ PDF.
• Putting Patients First from the NHC.

Please note: “Putting Patients First” does not include a search for augmentation therapy coverage; patients will need to confirm that coverage.

The Alpha-1 Foundation acknowledges the generosity of the National Organization for Rare Disorders (NORD) and the National Health Council (NHC) for allowing us to use their tools for searching out the right Marketplace Health Insurance for Alphas and their families.

Copay Accumulator Adjustment

If you use copay assistance from a third party or via copay cards, understand Copay Accumulators.   Private insuance companies have the option of instituiting a copay accumulator on any individual plan.  It is a way they can disadvantage you in obtaining costly therapies, including augmentation therapy.  If an accumulator is in play, the assistance will not count towards your out of pocket maximum.  Once your copay assistance reaches its maximum, you wil start to be billed and will continue to be billed until you reach your Out Of Pocket Maximum with your own funds.   Some quick tips:

• If you use copay cards, check your insurance plan to see about accumulators. Be sure to read the fine print or call your insurer to ask if the copay assistance card/coupon will continue to count towards your deductible and maximum out-of-pocket limit.
• Watch your Explanation of Benefits notifications that you receive from your insurer. If you use a copay card, you should see quickly whether or not the copay card payment is being applied to the deductible.
• It’s important you know when you’ll meet your deductible so that you aren’t surprised.

Here is a great video from the Hemophilia Foundation on copay accumulators:  https://www.hemophilia.org/Newsroom/Advocacy-Legislative-News/Copay-Accumulator-Adjustments-What-are-they-and-how-they-can-affect-you.