Medicare Open Enrollment: What you need to know when it’s time to select the plan for you
Older or disabled Americans with Medicare coverage have from Oct. 15 to Dec. 7 to decide on whether to switch from traditional Medicare to a Medicare Advantage Plan. This is also the time of the year when you should comparison shop your Medicare Part D drug prescription plan.
If you are already enrolled in a Medicare Advantage or drug plan, carefully read the “Annual Notice of Change & Evidence of Coverage” letter from your insurance company. This letter is not another sales pitch that we all receive most of the year in the mail. This letter is required by CMS to notify you of the cost and benefit changes in your current plan for the upcoming year. If you accidentally threw yours away, call you insurance company. When you receive it, make sure you read the changes and ask questions if you do not understand it. Which Road Do I Choose: Traditional Medicare Or
Medicare Advantage The open enrollment period is your opportunity to switch plans, including moving between the government-run traditional Medicare program and a Medicare Advantage Plan.
Medicare Advantage plans, offered by private insurance companies, receive payments from the federal government to help cover the costs of beneficiaries. They restrict members to their network of doctors and hospitals and a list or formulary of covered drugs. With some rare exceptions, you cannot leave the plan midyear, even if the plan drops drugs from the formulary or your hospitals, physicians, specialists or medical equipment suppliers leave the plan.
But unlike traditional Medicare, Medicare Advantage plans often cover dental, hearing and vision care. Some plans waive the three-day inpatient hospital stay before going into a skilled nursing facility. But most importantly, they cap your outof-pocket expenses. Once you reach that limit, the insurer pays for covered services, and you pay nothing. But keep in mind, the details of these plans — such as the caps on member spending, the premium prices and service areas — can change from year to year.
On the other hand, with traditional Medicare, patients can go to any provider who participates in the program, and most providers do. Because there is no limit on the share of medical expenses you pay, most folks purchase a Medicare Supplement (“Medigap”) Plan or have other insurance to lower those costs
Check Your Plan’s Network If you choose a Medicare Advantage Plan, make sure you check with the Plan to verify that your doctors, hospital and other providers are in the Plan’s network. You may also contact your physician’s directly to see if they participate with the Medicare Advantage Plan. Confirm Where Your Drugs Are
Available When choosing a drug plan, also known as Medicare Part D, the total costs of the drug plan are most important. Consider factors beyond the monthly premiums. You will pay different amounts when the plan first begins each year, than when you are in the coverage gap (called the doughnut hole) and after you reach the catastrophic stage.
Find out whether the lowest price is available at your favorite pharmacy or if you must travel elsewhere to get that price. Most plans offer their lowest prices only at their preferred, in-network pharmacies.
Also, ask what other restrictions apply. For example, do you need prior authorization or have to try another drug first before you can get the one your doctor prescribed? Also, will the price var y depending on the frequency or the quantity of your prescription?
You can also save thousands of dollars just by switching pharmacies. That’s because drug plan prices can depend on whether a drugstore is a preferred pharmacy within the plan’s network.
Do You Qualify For A Subsidy? Folks with a lower-income may qualify for the “extra help” subsidy that pays for the premiums of certain drug plans and other costs. They may also be eligible for assistance to reduce their share of medical costs in traditional Medicare.
Premiums and subsidy amounts can change each year, so if you already have the subsidy confirm that it is enough to cover the plan’s premium next year. Otherwise, you can be billed for the difference.
Watch The Calendar There’s a lot to consider and only seven weeks to do it. And remember, the Annual Open Enrollment Period is from Oct. 15 through Dec. 7.
Mike Zimmer is president of Bay State Insurance Agency Ltd. in Centreville. He is available to answer your questions or speak to your groups regarding Medicare, Medicare Advantage, Medicare Supplements and Medicare Part D (Prescription Plans). He may be reached at 410-758-1680.