Open Enrollment: Does Your Medicare Coverage Need a Tune-Up?Posted by Medicare Made Clear
By Philip Moeller
Medicare’s annual open enrollment, which is Oct. 15 through Dec. 7, is a great opportunity to review your Medicare coverage and make sure you have the best possible health insurance in place for next year. As I’ll later explain, this can be done easily by answering a few key questions, and I’ll point you to the tools you can use to get those answers.
It can be tempting to simply keep this year’s coverage in place. After all, enrolling in Medicare in the first place can be complicated. Then there’s the process of having to learn how to use the mix of plans you have. I can understand that the last thing many people want is to move away from something they know, even if there may be better solutions out there.
However, you need to know if the Medicare plans you now have will be changing next year. Premiums, copays and annual deductibles often change. So can prices for the drugs you use. Even if your Medicare plan offered you the best solution this year, this might not be true next year.
Also, even if your plans haven’t changed, your health needs may have. Are there new medications you need? Or perhaps you have some health issues that are either new or more pronounced than last year. Have you moved? Might you need to see new doctors? If you are in a Medicare Advantage plan, does its network of health care providers give you access to the specialists you may need? What are the consequences – in terms of cost and access to care – should you wish to use out-of-network providers?
Lastly, as I regularly tell people who bring their Medicare questions to me, Medicare decisions should be made for the future you, not the present you. People who’ve never been sick a day in their life may wonder why they need strong Medicare insurance protection. While today’s health care needs may be modest, they could intensify in the future.
So it makes sense to view Medicare Open Enrollment as the chance for an annual check-up of your health insurance needs. Here are the steps I recommend:
1—Know Your Options. In most cases, Medicare enrollees can do nothing and the plans they already have will renew for the next year. People with Medicare Advantage and Part D drug plans can switch to other such plans. Most Medicare Advantage plans include Part D coverage, so in essence they bundle all of your Medicare coverage together in one plan. You’ll sometimes see them described as MAPD plans for short. Someone with an MAPD plan is free to disenroll from that plan and instead rely on Original Medicare (Parts A and B). If they do that, they also need a stand-alone Part D plan to maintain their prescription drug coverage. Nearly all people have the flexibility to switch into or out of a Medicare Advantage or Part D plan each year during open enrollment, without the risk of being denied enrollment in the new plan.
This assurance may not be afforded to people with Medicare supplement (Medigap) plans who want to shift to different plans, different insurers or both. People who want Medigap coverage because they’re switching from a Medicare Advantage plan to Original Medicare will be in the same boat. After your Medicare Supplement Open Enrollment Period (the six months following your enrollment in Part B) has passed, private insurers offering Medigap plans, which are regulated at the state level, may be free to decline your request to enroll in a plan they offer, or attach pricing and coverage rules to that decision. You always should find out about any such conditions before deciding to change plans.
Here’s some information about Medicare Advantage vs. Medicare supplement plans.
2 – Know How Your Current Plans Will Change Next Year. By the end of September, your Medicare plans are required to have sent you a notice of any important changes in the plans for next year. If you have a Medicare Advantage plan or a Part D drug plan, these are called Annual Notice of Changes statements, or ANOCs. (Medicare loves acronyms!) The plans also should send you a detailed explanation of their rules. This is called Evidence of Coverage (EOC).
Medigap plans operate a little differently than Medicare Advantage and Part D plans in that the benefits aren’t subject to change each year, and they’re also guaranteed renewable, meaning your plan can’t drop you as long as you’re paying your premiums. Nevertheless, your Medigap plan will send you a shorter notice that will outline any change to the premium.
3 – Compare Your Current Plans with Other Offerings. Medicare.gov has detailed information about Medicare Advantage and Part D drug plans on its Plan Finder site. Take some time to learn how Plan Finder works, including viewing the video tutorial. Enter your specific prescription drug needs if you want the tool to provide the most informed and personalized comparisons among plans. You can store this information with password-protected access and come back to it later to make additional comparisons.
There also is a Medigap Policy Search tool that will let you compare Medicare supplement plans available where you live. If you need a refresher course on Medigap plans, which are designated by different letters of the alphabet, check out page 11 of Medicare’s helpful Medigap guide. All letter A plans (or B or C plans, etc.) sold by different insurers must offer the same basic coverage. However, insurers are free to set their own premiums for the plans. Substantial price differences are not uncommon, so shop carefully.
And keep in mind that you can enroll in a Medigap plan any time of the year, but with many Medicare enrollees actively thinking about their current coverage during open enrollment, this is an opportune time to consider your Medigap options as well.
Lastly, if you are thinking of dropping your Medicare Advantage plan and switching to Original Medicare, you should review Medicare’s annual Medicare & You guide to make sure you understand what Parts A and B of Medicare cover, and what they don’t.
4 – Let Your Fingers Do the Walking. Many Medicare enrollees are old enough to remember this ubiquitous Yellow Pages marketing slogan. Meanwhile our children and grandchildren may not even know what the Yellow Pages are! In any event, you should get in touch with insurers if you have any questions about open enrollment and the plans they offer in your area. They do answer their phones, especially during open enrollment season. So does Medicare. Call 1-800-MEDICARE (1-800-633-4227; TTY 711; available 24 hours a day, seven days a week). Also, you can get free Medicare counseling from the State Health Insurance Assistance Program (SHIP), which has trained volunteers around the country who should be familiar with Medicare rules where you live.
For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.
Journalist Phil Moeller is an expert on retirement and aging. He writes the “Ask Phil” column for the PBS NewsHour, is the author of “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs,” and the co-author of the updated edition of The New York Times bestseller “How to Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” You can follow him on Twitter @PhilMoellerTags: Changing Medicare Plans, Medicare Coverage Questions, Medicare Drug Plans, Medicare Open Enrollment Period, Medigap