Ask the Medicare Specialist

QUESTION:

I might be a bit premature, but is there anything those of us already on Medicare need to do or be aware of as we approach Medicare Open Enrollment this Fall? Do you have any early news of what changes we can expect? If “Medicare Expansion” is approved, will that affect us in 2022?

ANSWER:

Let me first clear up the difference between Annual Election Period (AEP) and Open Enrollment (OEP), which are often confused, as well as explain the other two enrollment periods as set forth by the Centers for Medicare and Medicaid (CMS).

I can’t believe it, but Annual Election Period is now less than three months away. AEP lasts 53 days and starts October 15th. I refer to it as somewhat of a free for all because this is when those on Medicare can make any change they want in their plan lineup, a move from one Advantage Plan to another, from an Advantage Plan to a Supplement (underwriting may be required), from a Supplement to an Advantage Plan, and/or from one Part D prescription plan to another.

OEP is a bit more restrictive. It runs from January 1st to April 31st and as it’s been explained to me, is designed for those who feel they made a mistake by changing plans or remaining on their current plan during AEP. In OEP, Medicare beneficiaries can make one of two choices; move from one Advantage Plan to another, or go from an Advantage Plan to a Supplement paired with a Stand-Alone Part D plan. The other two are the Initial Coverage Election Period (ICEP), and what is known as a Special Election Period (SEP). ICEP occurs the first time someone goes on both Medicare Parts A and B. It starts the three months prior to the Part B effective date, runs through the month of the effective date, and ends three months after the Part B effective date. During these seven months, those in this position can make their initial choice in Medicare Plans, either a Medicare Advantage Plan or Stand-Alone Part D and a Supplement. It’s also most likely the only time ever that one can enroll in a Medicare Supplement without going through Medical Underwriting. SEP’s can be used anytime during the year when one qualifies. They can occur when one moves to a new service area or loses insurance from an employer, a former employer, Medicaid, or other state or Federal programs. Those on PACE or PACENET, those who get “extra help” for prescription drugs, or are on Medicaid, have yearround SEP privileges.

Let’s discuss what those on Medicare shouldn’t do prior to or during AEP. Don’t assume you have the best value in plan because your premium will remain the same or similar in 2022 or you’ve been with the same company for years. These are the most common and costly mistakes that can be made. There’s no need to be afraid to move from one Advantage Plan company to another because all HMO and PPO’s are regulated to cover the same services as original Medicare and as good or better. There are also no issues with preexisting conditions being covered. Don’t let an insurance company prey on your fears!

There is one Advantage Plan company in particular that has taken advantage of many members’ blind loyalty and it’s my professional opinion they simply haven’t been competitive in years. It never ceases to amaze me how close to 100,000 seniors continue to remain with them. That being said, we have yet to see their 2022 benefits and it remains to be seen if they may finally be a company we advise our clients to consider.

That brings us to what those on Medicare should do. If you’ve been with one particular Advantage Plan HMO or PPO company for two years or more and aren’t a current client (we send all our clients an annual recommendation and list of changes in their plans), you should make a quick email to myself or 5-minute call to one of our offices. If you mention what company and plan you have, we can advise if it’s one we feel will be offering good value for the benefit year 2022, or if it would be prudent to set up an appointment for a more thorough comparison to other plans or companies. Those who bought a Supplement from someone other than The Health Insurance Store should also reach out to us. There’s an excellent chance we can get you a lower premium for the same exact plan letter.

In addition, if you don’t already understand or aren’t clear on the subject, you need to have the differences between Advantage Plans and Supplements as well as the pros and cons of each explained in detail. I’m always writing about those in the columns, but there’s no substitution for a oneon-one consultation, which we provide at no cost. Lastly, those who have Stand Alone Part D plans that piggy back their Supplements always need to have them reviewed, even if medications haven’t changed. The most popular Part D company among our clients, and possibly all of Western PA, is consolidating from six plans to three. We don’t yet know where those whose plans are going to be eliminated will be moved, but in my experience, it’s usually to one that provides the most profit for the Part D company, not a plan that saves the Medicare beneficiary the most money. Again, even if your plan hasn’t been eliminated or hasn’t seen much of a premium increase, it still needs evaluated. Companies can change drug tiers from a 1 to a 2, 2 to a 3, etc. They can also remove drugs from their formulary, resulting in more expenses or headaches trying to get a “Formulary Exception.”

As far as changes we can expect, at this time, I only know of one that’s of concern to me and that’s the Part D deductible increase for 2022. It’s going up to $485 from $445. Be advised in Western PA, the Part D deductible is only applicable to those on Stand Alone Part D plans, not Part D that comes with nearly all Medicare Advantage Plans. That doesn’t mean we might not see a deductible on HMO’s or PPO’s in the future. Right now, for example, in West Virginia, virtually all Advantage Plans have a $100 Part D deductible. However, as it approaches $500 on Stand Alone Part D plans that those on Supplements buy, there may be a breaking point where the deductible along with higher premiums for Medigap policies could force some people to move to an HMO or PPO.

I’m not privy to this as of yet, but I do expect some positive news regarding Advantage Plans. I believe one popular company who increased their MOOP significantly in 2021, is going to reduce it for 2022.

I also don’t see the two companies with the most enrollments in Western PA making many, if any, significant changes in their benefits as far as increasing co-pays, the MOOP, or eliminating or meaningfully reducing comprehensive dental and Over the Counter benefits on their most popular plans. As far as Medicare Expansion, which I discussed in last week’s column, affecting us in 2022. It will not. Even if the bill passes soon, there won’t be time to have those services covered by Medicare and Advantage Plans next year. I’m actually skeptical that the proposed expansion, coverage for comprehensive dental, vision, and hearing benefits, will be available by 2023.

With questions regarding this or any other column, or to set an appointment for a no cost consultation, please call one of our office locations or email me personally at aaron@getyourbestplan.com.