It’s that time of year again to evaluate your Medicare plan
The Medicare media blitz over the next several weeks will be intense. We haven’t decided whether there will be more TV and radio ads and direct mail during Medicare’s Open Enrollment season or during next November’s election. We’ll just have to wait and see. In the meantime, here are some important things to consider if you’re already enrolled in or about to enroll into Medicare.
Open enrollment season for the 65 million Americans covered by Medicare started on Oct. 15 and ends Dec. 7. During that time period, you can make changes to certain aspects of your Medicare coverage. These aspects include:
• Join, drop or switch to another Medicare Advantage Plan (or add or drop drug coverage).
• Switch from Original/Traditional Medicare to a Medicare Advantage Plan.
• Join a Medicare drug plan if you’re in Original Medicare.
• Switch from one Medicare drug plan to another if you’re in Original Medicare
Changes in coverage become effective on Jan. 1, 2024.
Many things can change each year. Your prescriptions may change and the drugs that are covered under your current plan could change in cost, so it’s wise to review your drug coverage annually.
In addition, there may be changes to hospital and physician networks, covered services and providers, so you want to make sure you are still covered for your anticipated health care needs for the next year. In 1965, there was just plain Medicare. In 2023, the average Medicare beneficiary can choose from 43 Medicare Advantage Plans offered by nine insurance companies along with Traditional Medicare and Medicare Part B supplements.
While a lot of attention is given to open enrollment, it is important to consider how one even gets into a Medicare plan in the first place and how to choose the best option. It’s a very personal decision. The initial enrollment period is three months before your 65th birthday, the month of your birthday and three months afterwards. In addition, the transition from other coverage (such as a prior employer) or after the death of a spouse are additional significant points of access to make decisions about which plan to choose.
We spoke with William McKendree, an authority on all things Medicare who is the executive director of the Pennsylvania Healthcare Benefit Solutions Program (“PHBSP”), a 501(c)(3) nonprofit organization. According to Mr. McKendree, PHBSP’s mission is “to help people navigate through the complexities of healthcare insurance and health care benefits.
“But, really most of what we do can be described as ‘cleaning up messes.’ And, unfortunately, most of those messes are the result of people relying on incorrect information and bad advice from entities that were supposed to be competent and trustworthy.”
Mr. McKendree’s advice when choosing health care coverage?
“Never trust anyone to care about you as much as you care about yourself. Always try to do your own research and get more than one opinion before you make a decision.”
Another thing to consider is the continuing expansion of Medicaid coverage, known as Medical Assistance in Pennsylvania. Many people who are on Medicare also have coverage through Medical Assistance for things that Medicare does not cover. People who have coverage under both plans are known as “dual eligibles.” So, it’s important to see if Medical Assistance coverage is an option as well.
In summary, health care is big business, and you need to monitor your plan annually and especially when there are life changing events.
Don’t wait until your 65th birthday to start learning about Medicare coverage. Initial enrollment is important and sets the course for your health care future.
There is a wealth of information available from the Center for Medicare Advocacy (www.medicareadvocacy.org) as well as www.kff.org, the web site for a non-partisan organization focused on health policy, in addition to the Medicare tollfree hotline, 1-800-633-4227.