What you Need to Know about Open Enrollment fo Medicare
The Medicare Annual Election Period (AEP) begins October 15th and runs through December 7th each year. It’s also known as Medicare’s open enrollment. A time when Medicare Beneficiaries can re-evaluate their coverage and make changes. It’s also a good time for those who didn’t sign up for a Medicare plan when first eligible to go ahead and enroll. What you Need to Know about Open Enrollment fo Medicare
Depending on the type of plan you have, you can make changes to your Medicare coverage during this time. Only under special circumstances that qualify as a Special Election Period, can Medicare Beneficiaries make changes outside the Annual Enrollment Period. That’s why it’s imperative that you understand when you can make changes.
For example, with Medicare Advantage Plans (also known as Medicare Part C) the Annual Election Period is when you can sign up, change or disenroll from the plan. The AEP allows Medicare Beneficiaries with Medicare Parts A & B to switch to a Part C plan.
In addition, Medicare Beneficiaries that are currently enrolled in a Medicare Advantage Plan (Part C) can disenroll in the Advantage Plan and enroll in a Medigap Plan, also known as a Medicare Supplement Plan.
The effective date for coverage elected during the Annual Enrollment Period will be January 1st of the following year.
Are you willing to change doctors to save money? If you are enrolling in a Medicare Advantage Plan, this will a topic on the table when you review your options. If you have any doctors that you are not willing to change, have that information handy.
It will help your agent research your options, and make sure the doctor you’d like to keep are in the preferred network of any Medicare Advantage Plan you are going to consider.
Your pharmacy can provide you with a list of the drugs and doses you are currently prescribed. This list is convenient when reviewing your Part D, Prescription Drug coverage options. Whether you are enrolling in a Medicare Advantage Plan or a Medicare Supplement/ Medigap plan, you will need to know if you are getting enough prescription coverage.
Prescription drugs are categorized into different tiers, with copayments/ coinsurance depending on the tier they fall under. The same prescription may have different costs, depending on the Prescription Plan you purchase.
Your agent will ask you for a list of your prescription so they can review those options available and advise which one will best suit your needs.
How to evaluate your options
Confirm your eligibility to enroll
To sign up for a Medicare Advantage Plan or a Medicare Part D Prescription Drug Plan, you must be enrolled in Medicare Part A and Part B and live in the service area of the Medicare Advantage Plan.
If you have end stage renal disease (ESRD), there are a few exceptions, but typically you cannot enroll in a Medicare Advantage Plan. You should contact Medicare for resources and options available.
Review changes to your situation and decide if your current coverage still meets your needs
Before the Medicare Annual Election Periodbegins, review the coverage you have in place. Consider the health benefits your current policy offers and weigh it against the benefits you’ve utilized over the previous 12 months.
You will receive an Evidence of Coverage from your current insurance carrier every fall. Use this document to review against your expected needs for the upcoming calendar year. Of course, nothing takes the place of a licensed insurance agent that can help you review the many options available.
Verify that your Medicare Part D, Prescription Drug Coverage is considered creditable. That means the coverage is expect to pay at least as much as the standard Medicare Prescription Drug Plan. If you go for 63 or more consecutive days without creditable drug coverage, you may incur a Medicare Part D late enrollment penalty. That penalty never goes away.
If you already have a Medicare Advantage Plan (Part C) in place, you should check to see if your current plan offers dental and /or vision coverage. Usually, these ancillary benefits require a separate enrollment.
For most people, changes occur and our health coverage needs are no exception. It’s worth the time invested to make sure you have the coverage needed before it’s too late.
Be conscious of how enrolling in a Medicare plan may affect other insurance coverage
Coverage such as Tricare for Life or a Federal Employee benefits plan could be impacted if you choose to enroll in other Medicare Coverage. Before making any changes, be certain to speak to your licensed agent or benefits administrator to find out how your insurance works with Medicare.
There are some plans that require you to have Medicare to maintain eligibility, while others will cause you to irreversibly lose your coverage if you enroll into a Medicare Advantage or Prescription Drug Plan.
We should really stress that if you have a retiree benefit plan, please contact your benefits administrator to be sure you understand your obligations in maintaining that coverage. Most plans that are offered to retirees just can’t be beat, so exercise caution if or when you choose to review other options that may be available.
Consider the cost of your coverage
With Medicare Advantage Plans, your insurance company reviews the plan benefits and premiums they charge, every year. Adjustments are made as needed to keep the premium/ loss ratio within the regulatory requirements.
Just as the insurance companies review the policies every year, your licensed agent can shop around and help you compare prices for the best coverage that will meet your anticipated needs and budget for the upcoming year. It has nothing to do with loyalty and is strictly dollar driven. Take advantage of the knowledge agents have to offer. Remember, the agent works for you.
Be cognizant of total cost sharing expenses. A lower premium doesn’t necessarily mean you’ll save money if it’s offset by high deductibles or copayments.
Medigap Plan benefits do not change. Medigap or Medicare Supplement Plans are regulated by Medicare and the benefits do not change. These are the plans that are differentiated by letters, such as Medicare Supplement Plan F or G. It is of interest to note, there are at least ten different Medigap plans currently available.
Any rate increases must be submitted and approved by Medicare. With a Medigap plan, the coverage is the same for a Plan F no matter who underwrites the policy. Medigap Plans cost a little more in premium than an Advantage Plan, but leave the insured person with less out of pocket expenses when seeking medical treatment.
What Can You Do
Working through the intricacies of Medicare can be like navigating through murky water. Frankly, you never really know what’s below the surface. You need a trust licensed insurance agent. The agent works for you, as a matter of fact, the agent has a fiduciary responsibility to help you find the best plan to meet your needs and budget.
Contact your pharmacy and ask them to provide you a list of your medications and doses. Then make a list of the doctor’s you want to be in your network. Determine what benefits are “deal breakers” when you start looking over your coverage options this fall.
Gather your receipts from copayments and coinsurance that you’ve paid for the current 2017 year. Then seek out your agent to help you review the data and make an informed decision as to which coverages will best suit your needs in 2019.
What you Need to Know about Open Enrollment fo Medicare
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About the Author
Jagger Esch is the President & CEO of Elite Insurance Partners and MedicareFAQ, a senior healthcare learning resource center. As a young entrepreneur and seasoned insurance expert, he has a passion for helping people. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. Jagger lives in the Florida sunshine state and loves boating with his family on the weekends.View All Articles