The Medicare open enrollment period (or annual election period) began on October 15 and will continue until December 7. This is the time of year when you can make changes to an existing Medicare Part D prescription drug plan, purchase a Medicare Advantage plan, or otherwise make changes to your Medicare coverage.
Even if you are sure that you do not need to make any changes or are completely happy with your current plan, it makes sense to review your coverage at least once a year. After all, you may be able to find a comparable plan for a lesser premium, or you may find that you need to make a few minor changes to the coverage you have.
What Should I Be Looking for When I Review?
There are several questions you should ask yourself when reviewing your current coverage to decide if it is adequate.
• Have my prescriptions changed? If you are now taking medications that your current plan does not cover, you may want to add a Medicare Part D prescription drug plan or switch to a Medicare Advantage plan. If you currently have a Medicare Advantage plan that does not include prescription drug coverage, you could switch to a different Advantage plan at this time.
• Have my health needs changed? If you are currently only participating in Medicare Parts A and B but are concerned that you may be facing additional medical expenses in the coming year, you may want to consider replacing your Original Medicare with a Medicare Advantage plan.
• Has my income changed? Although it is never a good idea to reduce coverage in order to save money, the reality is that often your income does have a negative effect on your health care. If your income has been reduced drastically for any reason, you may qualify for Medicaid or lower premiums on your Medicare Part B.
How Do I Decide Which Plan Is Best?
What’s best for you will depend on what’s important to you. If you are okay covering some deductibles and coinsurance, and you like the doctors in the network, I would encourage you to choose a Medicare Advantage plan. These types of plans typically provide the most comprehensive coverage relative to cost. Medicare Advantage plans are available with or without prescription drug coverage.
If you want the freedom of going to any doctor who accepts Medicare, or the security of knowing that virtually all your medical expenses will be paid, a Medicare supplement plan might better fit your needs. The best way to decide which plan is right for you is to talk to an insurance professional. Not only can he or she help you decide which plan will benefit you the most, but he can also help make sure you pay the least amount possible for it.
What Things Do I Need to Watch Out For?
The most important aspect of either your Medicare Part D or Medicare Advantage plan is how your prescription drugs are covered. Different drugs are placed into different tiers, which is how the cost to you is determined. You want to be sure that the drugs you are currently taking have not been moved into a different (and likely more expensive) tier, as that can increase your out-of-pocket expenses considerably.
Just because you have always been on the same two drugs and they have always been in one particular tier does not mean they will stay that way. If necessary, you can ask your doctor to switch your medication to a comparable one in a lower tier in order to better afford it.
There have also been changes in where you can have your prescriptions filled. Some companies have preferred pharmacies, and you can only receive the lower price if you have your prescriptions filled there. This could be especially problematic if you live in an area where there is no preferred pharmacy close by.
Although I know that cost is always a consideration (after all, my No. 1 goal is always to help people save money on their medical expenses!), I also want to remind you that paying a lower premium does not always mean you are going to pay less overall. When you are conducting an annual policy review to decide whether you need to make changes or not, it is imperative that you do all applicable calculations before making a purchase.
People often consider the premium total alone and later discover that they are not covered for the really important things. Or they see the total and know they can afford it, so they do not read the fine print. Many different companies charge a lower premium but recoup their money by requiring a larger copayment. If you see a doctor regularly for any reason, these costs can soon become overwhelming.
Don’t Go It Alone
No matter what changes you need to make to your coverage (if any), it is important that you take a detailed look at your current coverage to compare policies and prices.
The open enrollment period for Medicare is the only time of the year when you can make changes to a prescription drug plan, switch from Original Medicare to a Medicare Advantage plan, or change your Medicare Advantage plan back to Original Medicare (there are circumstances where you might be able to purchase one of these plans outside the enrollment period, such as if you are not yet 65 during the open enrollment period).
Also, keep in mind that the team at MediGap Advisors is here to help you review your current coverage and decide if you need to make changes. Our Personal Advisors can discuss your options with you and help you come up with a coverage plan that will fit your needs, as well as your budget. Our services are offered to you at no cost—we simply want to help you spend your health care dollars wisely. Please call us at 866-323-1441 and let us guide you through the open enrollment period!
Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.