Starting Jan. 1, Medicare Part D drug plans cannot charge you more than $35 for a one-month supply of the covered insulin you take.

In addition, you cannot be changed a deductible. This $35 per month charge also applies when you order 60 or 90 day supplies. When you are looking at Medicare Advantage plan coverage you should be aware that this new cap may not yet be factored into their premiums.

For insulin used with a traditional insulin pump that is covered under the Medicare durable medical equipment benefit, you pay 20% of the Medicare-Approved amount after you meet the Part B deductible.  You pay 100% for insulin-related supplies (like syringes, needles, alcohol swabs, and gauze), unless you have a Part D plan covering these items. Starting July 1, 2023 similar caps on costs will apply for insulin used in these traditional insulin pumps.

Fall Open Enrollment: The Open Enrollment Period runs Oct. 15 – Dec. 7. In next month’s column we will have a report on the outcomes of this year’s enrollment period. While we focus each year on the Fall Open Enrollment period, there are other enrollment periods that you should keep in mind. This is especially true if you are turning 65 and enrolling in Medicare for the first time.

Initial Enrollment Period: The period of time when you first enroll in Medicare is known as your Initial Enrollment Period (IEP). The IEP is a 7-month period that begins three months before your birthday month, the month you turn age 65 and ends three months after your birth month.

Currently, when you initially sign up for Medicare you may wait several months for your coverage to take effect. These waiting periods have been eliminated. Here is a summary of the new rules provided by the Centers for Medicare & Medicaid Services (CMS):

Enrollment before your birthday month: Your coverage will now start during the month of your birthday.

Enrollment during your birthday month: Your coverage will begin at the start of the following month.

Enrollment after your birthday month but during the IEP: Coverage now starts the month after you sign up.

Medicare Advantage Open Enrollment Period for 2023. If you missed the fall Open Enrollment Period, you may be able to take advantage of the annual winter Medicare Advantage Open Enrollment Period. This period, which runs from Jan. 1 through March 31 each year allows you to make some changes to your coverage.

During this period, if you’re enrolled in a Medicare Advantage Plan you can switch to a different Plan. However, you can only switch plans once during this period. Also, you can drop your Advantage Plan coverage and enroll in Original Medicare as well as a Part D drug plan. The one thing you can not do is change from Original Medicare and enroll in an Advantage plan. Under normal conditions you can only switch from Original Medicare to an Advantage plan during Fall Open Enrollment.

If you make changes during the Medicare Advantage Open Enrollment Period these changes will now start the month after you make the changes. In the past it would take several months for your new coverage to begin so this new start date is a major change by CMS.

Special Circumstances (Special Enrollment Periods): There are a number of Special Circumstances Enrollment Periods that are triggered by events that are beyond your control. Some of the of the events that allow you to change your enrollment include:

You change where you live: If you move it may mean that you no longer live in your current plan’s service area or the options you want are no longer offered by your current plan at your new address.

You lose your coverage: Circumstances that fall into this category include that you are no longer eligible for Medicaid or that you have lost your employer-based coverage.

Your plan changes its contract with Medicare: This can include a number of things, including Medicare terminating or ending their contract with your plan and, therefore, you no longer have coverage.

• The Oneida County HIICAP Office is continuing to provide counseling services and in-person scheduling by phone as they have throughout the pandemic. If you would like to do a HIICAP counseling session over the phone or schedule an appointment at one of the two in-person locations call 315-798-5456 and select No. 2 from the choice list. In most cases you will be asked to leave your contact information on a voice mail and a staff member will return your call within 72 hours (three business days). Counselors are available at the following locations:

• Copper City Community Connection, 305 E. Locust St., Rome, will offer counseling session from 9 a.m. to 3 p.m. on Thursday only. The HIICAP program will also be scheduling at Copper City.

• North Utica Senior Citizens Center, 50 Riverside Drive, Utica. Hours have been expanded at this site. Appointments will now be accepted on Monday, Wednesday and Friday from 9 a.m. to 3 p.m. Sessions are expected to run 45 minutes. Call the HIICAP office at 315-798-5456, selecting option 2 to schedule an appointment.

Contacting HIICAP Programs in Other Counties: Here is the contact information for HIICAP programs in several counties that border Oneida County. To reach the Madison County HIICAP program call 315-697-5700 and ask to speak to a HIICAP counselor. For Herkimer County, call Catholic Charities of Herkimer County at 315-894-9917. For Lewis County call 315-376-5013 and select #2 from the choice list.

Dr. William Lane is the owner of William Lane Associates, a gerontological consulting firm located in Homer. He writes a monthly column on HIICAP related issues for the OFA. Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.