Medicare shopping is anything but pedestrian
Every year, as sure as the sun rises in the east with mundane regularity, Medicare’s open enrollment period runs from Oct. 15 to Dec. 7.
But there’s really nothing mundane about this time of year when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year.
And this year, just as in years past, experts have advice to offer.
NOTHING REMAINS THE SAME
Each year, Medicare health and drug plans can and do make changes to such things as cost, coverage and what providers and pharmacies are in their networks, according to the Centers for Medicare and Medicaid.
Given that, CMS says Medicare beneficiaries should review the materials their plans send them, such as the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC). And if there are plan changes, they should make sure their plans will meet their needs for the following year.
“If they’re satisfied that their current plans will meet their needs for next year and it’s still being offered, they don’t need to do anything,” the CMS notes.
According to Katy Votava, president of Goodcare.com and author of Making the Most of Medicare: A Guide for Baby Boomers, the goal is to maximize your in- and out-of-network coverage and your prescription drug coverage, especially since there’s wide variation between plans.
Votava says it’s worth noting plans vary from county to county, even at the ZIP code level.
In addition to using Medicare’s online tool to compare and contrast plans, Votava recommends getting advice from local coverage brokers or from your local council on aging.
MEDICARE VS. MEDICARE ADVANTAGE
Consider evaluating whether to move from your existing Medicare plan to a Medicare Advantage plan, from one Medicare Advantage plan to another or your Medicare Advantage plan back to an original Medicare plan.
Of note, Medicare Advantage plans had 46% of physicians in a county in-network, on average, but some specialists, such as psychiatrists (23%) were in shorter supply, according to a recent Kaiser Family Foundation study.
Kaiser found broader networks tended to have higher premiums, and about one in three Medicare Advantage enrollees were in a plan with a narrow network, those offering access to fewer than 30% of doctors in a county. Kaiser says it’s often difficult for Advantage enrollees to figure out if they are in a plan with a narrow, medium or broad network.
MEDICARE DON’TS
According to Votava, Medicare beneficiaries should not assume that their drug and health service co-payments, deductibles and coinsurance will stay the same next year. In addition, don’t go without Medicare creditably coverage for more than 63 days.
And, don’t assume your coverage cannot be changed outside of the annual enrollment period. There are, she says, exceptions. And whatever you do, don’t wait until the last minute to shop.
In some cases, the plan might not have changed but your needs have. In that case, you definitely want to review your options.