Medicare open enrollment begins quickly. Why you must listen


Female doctor working with elderly patient in a modern office clinic / hospital

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Sure, there are probably more fun things to do than check your Medicare coverage.

Still, it’s about this time of year. You can make changes to the open registration, which starts on October 15th and runs until December 7th, which will take effect on January 1st. While you don’t have to do anything – your 2021 coverage would generally last through 2022 – it’s worth at least double-checking that your current plan remains the best option, experts say.

“Providers can opt to or opt out of a network plan, or the cost of a prescription drug can be higher, lower, or may no longer be covered,” said Elizabeth Gavino, Lewin & Gavino founder and independent broker and general agent for Medicare Plans.

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Simply put, this annual subscription period is for adding or changing coverage related to an Advantage Plan (Medicare Part C) and / or Prescription Drugs (Part D). You can change, add or delete these parts of your cover.

However, the majority of beneficiaries don’t even compare plans, said Juliette Cubanski, deputy director of the Kaiser Family Foundation’s Medicare Policy Program.

“This is worrying as we know what we know about the changes from year to year,” said Cubanski. “Even if you are happy with your plan, it is worth taking a little time to see if you can find a plan with better value or coverage for your needs.”

Also note that while Congressional lawmakers are debating whether to add dental, eye, and hearing protection to the original Medicare, there is no assurance that the provisions will go through the entire legislative process. And if you have an Advantage Plan, you may already have some coverage for these benefits.

Here you can find out what you should know about open enrollment.

Who should be careful

About 63.3 million people get their health insurance through Medicare. Most of them – 55.1 million – are 65 years of age or older, while the rest are people with permanent disabilities.

Fall enrollment differs from your initial enrollment period, which begins three months before the month of your 65th birthday and ends three months after. Then you usually have to register for Part A (inpatient care) and Part B (outpatient care), unless you encounter an exception, such as B. an acceptable coverage elsewhere. You can also sign up for an Advantage plan or a Part D prescription medication plan (both offered by private insurers) during your first enrollment period.

Nonetheless, open registration affects most beneficiaries in one way or another because of the coverage they choose. For example, 26.7 million choose to get their Part A and B benefits through Advantage plans, which are likely to include Part D.

The rest stays with the original Medicare (Part A and B) and often combines it with a separate Part D plan. Some also get a Medicare add-on plan (also known as Medigap) offered by private insurers.

A total of 48.5 million beneficiaries have prescription drug coverage through either an Advantage plan or a stand-alone Part-D plan.

The essentials

Each year, usually by September 30th, your Benefit or Prescription Drug Plan should send you a package explaining the changes for the coming year.

This could include adjustments to monthly premiums, deductibles, deductibles, co-insurance or maximum out-of-pocket expenses, or changes to drug coverage, said Danielle Roberts, co-founder of insurance company Boomer Benefits.

The average monthly premium for Advantage plans will be $ 19 next year, up from $ 21.22 in 2021, according to the Centers for Medicare & Medicaid Services. The average monthly premium for Part D in 2022 is $ 33, up from $ 31.47 this year.

Part B’s monthly premiums – as well as various other cost details – for 2022 have not yet been finalized. However, according to Medicare’s latest trustee report, the standard Part B premium is expected to increase from $ 148.50 to $ 158.50 this year.

It pays to take a little time to see if … you can find a plan that is better value for money or better coverage for your needs.

Juliette Cubanski

Associate Director of the Kaiser Family Foundation’s Medicare Policy Program

Be aware that some Part D plans are collapsing, Roberts said.

“If you are on a medication plan that is being discontinued, it is likely that your insurance company will [move you] on one of her other drug plans for next year, “said Roberts.

In some cases, the other plan may have a significantly higher premium, she said.

“You don’t want to find out in January when it’s too late to change your standalone Part D drug plan,” Roberts said.

The same applies if you realize too late that your medication is not covered or involves much higher expenses.

However, if you decide on an Advantage plan during the fall enrollment and later find that it doesn’t fit well, you can change your coverage between January 1st and March 31st with Original Medicare and a Standalone Prescribing Plan.

What to look for in Advantage plans

While insurers offering Advantage plans are state regulated, the details can vary widely from plan to plan, county to county, and year to year. Some may offer extras such as dental, vision, or hearing aids, or may come with no premium (although you would still pay your Part B premium).

It is important not only to focus on this monthly amount, said Cubanski from the Kaiser Foundation.

“People might want to be careful about what a hospital or qualified care facility plan charges,” she said. “Even if you don’t think you need to be hospitalized, it is worth finding out how much you would pay out of pocket if something happened.”

Unlike the original Medicare plans, Advantage plans have caps so you know what your worst case scenario would be. However, these limits may vary depending on the plan, as may deductibles and other co-payments.

Also, make sure your preferred doctors, hospitals, or other providers continue to join the plan’s network. And, assuming the plan has prescription drug coverage (most do), make sure that any prescriptions you are taking are still covered.

Abandon a benefit plan

If your Advantage Plan isn’t working for you and you want to give it up altogether instead of switching to another, you can do so.

You would simply be left behind with Original Medicare (Parts A and B) and would need to get a standalone Part D prescription medication plan if you wanted that coverage. (If you don’t and later change your mind, you could face a fine for not doing it.)

However, although beneficiaries in this situation may wish to purchase a Medigap policy, rules apply to enrolling in a policy. Generally, unless you live in a state that has different rules or you make an exception, the first time you sign up for Part B, you will be given a six month window to buy Medigap without answering health questions and for pre-existing medical conditions to be punished.

If there is any underwriting, it’s wise to apply for the Medigap policy early this fall filing window and stick to your Advantage plan until you know you can get the extra coverage, Roberts said.

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