The open enrollment for Medicare coverage is just around the corner. With so many healthcare options available in the marketplace, choosing the best health insurance plan in line with your requirements might be challenging. After all, selecting a program that isn’t a good fit can cost you a lot of money.
Medicare specialist Sarah Murdoch advises clients to use an elimination process to reduce stress when selecting a health coverage plan. “If you see 30 programs available to you, eliminate those plans that don’t include your doctors in their network or your medications in their formularies”. It’s easier to compare plans once you’ve narrowed them down to a few options.
We’ll look at some expert tips to help you make the most of Medicare open enrollment.
1) Do not pay for items that you don’t need
“The most common mistake people make is failing to reevaluate their medical care coverage for the coming year,” Murdoch says. Despite this, in a 2019 government survey, more than 7 in 10 Medicare enrollees said they didn’t shop around for health plans the previous year. “In reality, policies change throughout the years.” Premiums may rise, specialists and doctors may leave provider networks, and copays and deductibles might increase.
Most importantly for people with Part D coverage, particularly those who take expensive medications: Drugs can be excluded from formularies. Prescription coverages may be moved from a lower pricing tier to a higher one, increasing your out-of-pocket expenses for each refill. Taking a close look at your Part D plan once a year can save you from unexpected cost hikes.
Over time, Medicare “choice errors” can cost you hundreds and thousands of dollars. Analysts cited by the NCOA (National Council on Aging) estimated how much Medicare Advantage beneficiaries spent on out-of-pocket costs and insurance premiums. Later, they compared that total to the estimated benefit for each person. The greater the difference, the greater the “choice error.” They discovered that many people overpay for their services and, despite this, rarely switch plans. According to the NCOA, “the magnitude of these “options or choice errors” can increase over time.”
2) Be aware of the timeline and Medicare open enrollment deadlines
Most people can make changes to their Medicare coverage only during the annual open enrollment period (from October 15 to December 7). However, you do not need to wait for October to start looking into insurance options. “Begin early,” advises Murdoch. “It is always preferable to have enough time to conduct the necessary research.”
You can do the following during open enrollment:
- Sign up for a new Medicare Advantage (MA) plan.
- Participate in a new ‘Part D’ or prescription drug coverage plan.
- Switch from traditional Medicare (with or without Part D coverage) to a MA plan.
- Switch from the Medicare Advantage plan to standard Medicare (plus Part D)
- Change your Part D plans.
- Switch your Part D programs again if you find a better health plan option.
You are free to make as many adjustments as you want. Your final plans will go into effect on January 1. If you have recently purchased your Medicare plan, note that your Initial Enrollment Period or IEP begins three months before your 65th birthday and ends three months later. It’s best to start looking for a health plan before your 65th birthday so you can register and begin receiving benefits as soon as possible. This will help you avoid unnecessary gaps in your coverage.
Also, if you’re purchasing Medicare supplemental insurance (or Medigap policy) for the very first time, make sure to do so within your first six months of eligibility. During that time, you can purchase Medigap without going through medical underwriting.
3) Compile all of your relevant medical information for Medicare open enrollment
Having important healthcare information on hand will make your Medicare shopping experience run more smoothly. Gather the following items:
- A current list of the prescription drugs you use, including recommended dosage and frequency
- A list of all your doctors and specialists
- Your preferred pharmacy, along with its address
- The total amount you paid for deductibles, premiums, and copays in the previous year
Each member of a married couple should have this information ahead of open enrollment. Prepare to shop alone, as there is no discount for having the same Part D coverage as your spouse.
Remember that any existing insurance plan you may have, like a group plan through your employer, could impact your Medicare benefits. “If people have other health policy or drug coverage, they should speak with their insurance provider or other benefits administrator before changing their health plan,” says a representative for CMS (Centers for Medicare & Medicaid Services).
4) Examine any modifications to your current Medicare program
If you have original Medicare, consult the most recent Medicare & You handbook to get an overview of the coming year’s costs and benefits. Page 2 contains a list of new and significant facts. You can find more details in other Medicare publications or on the state agency’s website.
If you have Medicare Advantage or Part D plan, you should have received an ANOC (Annual Notice of Change) or EOC (Evidence of Coverage) by email. It would have arrived in your mailbox by September 30. (If yours hasn’t arrived yet, contact your insurance company right away). The ANOC or EOC reports any changes to your plan’s benefits, costs, or rules for the coming year.
Such modifications could include:
- Premium costs
- Maximums for out-of-pocket expenses
- Your network’s providers
- The cost of medicines on your plan’s formulary
- New rules for step therapy or prior authorization
“With Medicare Advantage, supplier networks can change; thus, make sure you can reach out to all of the providers and prescriptions you need for the following year,” says Murdoch.
Even if you enjoy your current Medicare Advantage plan, it may not be the best option for you. The program could be ending, or its policies might be changing. Alternatively, you may be able to get everything you require from a less expensive plan. Examining the specifics will help you make a more informed decision. If you decide to switch but miss the fall open enrollment period, don’t worry. You can do so during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.
5) Use online tools and get free one-on-one assistance to shop for Medicare plans during open enrollment
There’s no need for you to make these decisions on your own. There are numerous Medicare-related tools and resources available for consultation. Here are a few examples:
- Medicare Plan Finder
- Medicare & You: A User’s Guide
- Health government online portals
- Health Insurance Assistance Program for Residents of the State (SHIP)
- Begin your search for a Medicare plan using the Medicare Plan Finder. Enter your ZIP code to see what health plans are available in your area. To narrow your options, include more information about your desired health and drug coverage. Enter all of your prescriptions for a detailed side-by-side comparison of health plans and costs. Switching programs may save you money if you take specialty medications or if new generics become available.
Check supplier networks, preferred pharmacies, and drug formularies for every person. “Married couples should base their decisions on their physicians and prescriptions, not those of their spouses or household members,” Murdoch says.
If you need any further help, call 844-844-3049 (TTY: 1-800-855-0511) 24 hours a day, seven days a week. People who prefer live chat can do so 24/7. (However, call centers are closed on major holidays.)
Contact SHIP for personalized assistance with Medicare enrollment or changes. This organization has offices in all 50 states and Puerto Rico, Guam, the District of Columbia, and the United States Virgin Islands. Moreover, the Association for Community Living supervises it. SHIP staff and volunteers provide free, one-on-one assistance with state-specific information.
“You have trained caregivers who assist with these program selections, and they have many years of knowledge on how to do the research and paperwork,” Murdoch says. SHIP counselors are also familiar with the reputations of health programs and provider networks. Make an appointment with your SHIP office early to avoid the rush near the deadline.
The Bottom Line
The open enrollment period for Medicare allows all beneficiaries to make adjustments to their coverage. Please take advantage of it. Examine your previous year’s expenses, your current plan, and any new changes to it, do some comparison shopping, and consult with a counselor if you have any questions. If you shop wisely during Medicare open enrollment, you’ll be grateful all year for having the right coverage at the best price.
- The annual open enrollment period for Medicare coverage is from October 15 to December 7.
- Many seniors overpay for the Medicare plan because they continue to use the same coverage year after year, even if their medical needs change.
- It’s critical to read your plan’s notices to learn about next year’s coverage.