Summer is still on, but it’s time to think ahead about your Medicare coverage. Every year, Medicare beneficiaries have the opportunity to change healthcare options. The Medicare Open Enrollment Period (also called the Medicare Annual Election Period) runs from October 15 to December 7 each year. It is possible to make changes outside of this period, but the process is much easier during Open Enrollment. This is an opportunity to rethink the insurance plans you have chosen, either Original Medicare with Part D coverage or Medicare Advantage.
Why Consider a Change?
There are several possible reasons to consider changing Medicare coverage. The most common may be that your circumstances have changed, making your old coverage now inadequate. Most people join Medicare at age 65, a relatively young and healthy senior. By the time they reach age 75 or 80, this situation can change. They may need to see new specialists, take different drugs, or have specialized care.
Patients who have chosen Original Medicare with a Part D Prescription Drug plan probably have no vision or dental coverage. Many Advantage plans offer some vision and dental benefits, along with other programs not provided by Original Medicare. This added coverage may motivate you to change to an Advantage Plan. Advantage Plans often offer out-of-pocket savings compared to Original Medicare plus Plan D insurance premiums. With inflation biting at everybody’s budget, changing might make sense. However, you should investigate the details of any new plan before changing.
If you are already a member of an Advantage Plan, you will want to make sure that the providers (doctors, hospitals, pharmacies, etc.) you favor will continue to be “in-network” members of the plan. Going out of network can be costly to Advantage Plan members, and each year the network may add or drop providers. By investigating other Advantage Plans in your area, you may find a plan that better meets your needs.
What Do You Do Now?
Starting early in October, you will be showered with printed and broadcast material inviting you to join a given Medicare plan. Some of this advertising can be confusing, misleading, or inappropriate for your situation. To make the best choice, you need to begin thinking about this decision now; gather some essential information you will need. Here are some basic suggestions:
- Make a list of the providers you use. This should include physicians, labs, hospitals, pharmacies and any special services (i.e., physical therapy) that you use.
- Determine how much you have paid out-of-pocket for these services in the past year. This will include deductibles, co-pays, out-of-network charges, etc.
- Make a list of all the drugs you take and estimate your out-of-pocket expenses for each of those medicines. Are you taking any new medicines and are they on your plan’s drug formulary?
What Can You Do During Open Enrollment?
During Open Enrollment, you can easily make these choices :
- Change from Original Medicare to an Advantage Plan. You must live in the Advantage Plan’s service area and be enrolled in Parts A and B to join an Advantage Plan.
- Move from one Medicare Advantage plan to another.
- Change from an Advantage Plan to Original Medicare plus a Part D plan, and probably a Medigap Supplemental plan.
- Switch between Part D plans.
- Drop your Part D coverage altogether (you won’t be able to re-enroll until the following year’s Open Enrollment Period, and a late enrollment penalty may apply when you eventually re-enroll).
- Enroll in a Part D plan if you didn’t enroll when you were first eligible. A late-enrollment penalty may apply if you have not maintained other creditable coverage.
Think Carefully About Any Change You Make
Using the personal information, you have gathered, think about the changes you are considering. Do not act solely on the advice of a well-meaning friend. Find out what each option means for you. What drugs are covered, what doctors are in the network, and what perks or extras are included? Here are a few key points to remember:
- All Medigap letter plans (Medigap Plan A, B…N) provide the same coverages, but they may cost significantly more or less. A Medigap Plan N sold in New York City has the same coverage as one sold in Gainesville, Florida, but it may cost more. There can even be price differences in identical plans sold in the same locale, so shop if a Medigap plan is your choice.
- Many people confuse the terms “Initial Enrollment Period” and “Annual Open Enrollment Period,” and there is a critical difference. During Initial Enrollment (first-time Medicare enrollment), you are guaranteed acceptance into any Medigap letter plan without any question. If you drop out of that Medigap plan to join an Advantage Plan, this may not be true. After your Initial Enrollment has expired, an insurance company may decline to write a Medigap policy or require a medical exam before doing so.
- Part D Prescription Drug Plans vary widely, so be sure to compare closely.
- Advantage Plans are local organizations with specific sets of in-network doctors. Many Florida seniors spend considerable time out of the state. This may make Original Medicare plus Part D coverage a better choice.
- Advantage Plans vary widely. All Medigap letter plans are the same, but not so with Part C or Advantage Plans. There can be significant differences in-network providers, drug coverage and plan extras. Shop and compare.
Where Can I Get Help and Answers to My Questions?
Medicare maintains its official website with up-to-date information and answers to your questions. Go To Medicare.gov (the Official Medicare Site) to start navigating to the information you need. These two shortcuts might get you the answers you want a little faster- Find Medicare Providers Near You and Find Health and Drug Plans Near You.
Stay Tuned!
Yes, keep coming back to OurSeniors.Net for the kind of information that helps you make the best choices. As your senior living magazine and online senior living magazine of choice, we will continue to inform you about topics like senior housing news, living in Florida, Social Security issues, and Medicare options.
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