Medicare Open Enrollment: 7 Things to Review
Medicare Open Enrollment is around the corner, so let’s get prepared for the annual blitz of ads for Medicare Advantage plans that you will be seeing daily beginning in October through mid-December. While we all know that this is something that happens each year, each year brings its own list of questions and challenges: Should I stay with my current plan? Should I change to a new plan? Should I remain on Medicare? Do I need a Medigap Plan? These are all relevant and important questions not only for beneficiaries but also for their children and caregivers.
To prepare for Medicare Open Enrollment, it's important to gather and review certain documents and information to make informed decisions about your healthcare coverage. Here is a checklist of items you should have ready to review.
1. Current Medicare Card
Ensure you have your Medicare card handy, as it contains your Medicare number and other essential information.
2. List of Current Coverage
Details of your current Medicare plan(s), including Medicare Part A (hospital insurance), Part B (medical insurance), Part D (prescription drug coverage), and/or Medicare Advantage (Part C) plan.
Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents, which outline changes in your current plan's costs, benefits, and rules for the upcoming year.
3. List of Current Medications
A detailed list of all your current medications, including dosages and frequencies. This will help you compare prescription drug plans (Part D) to ensure they cover your medications at the best cost.
o All Medicare Advantage plans with integrated Part D coverage (MA-PDs) have a formulary (the covered drug list) that categorizes prescription drugs by tier. Medicare Part D plans typically use a system of cost tiers to rank prescription drugs according to their cost. Out-of-pocket costs for the enrollee are higher for higher-tier drugs. The lower the tier, the lower your out-of-pocket costs under that plan.
o If a medication you take regularly has recently moved from a lower tier to a higher tier under your Advantage plan, then that could be reason enough to switch. This especially holds true if your prescriptions land you in a specialty tier – the most expensive option on the table for brand-name drugs, and, occasionally, generic drugs as well.
o It could also be the case that you have recently been prescribed a new drug that is not on your plan’s formulary, or that is in a high tier, and you’re able to find another plan that covers it with lower out-of-pocket costs.
4. Healthcare Providers and Pharmacies
A list of your preferred doctors, specialists, hospitals, and pharmacies. Make sure your preferred providers are in-network with any plan you are considering. One downside to Medicare Advantage is that unlike Original Medicare, it limits you to a specific network of providers. If you have a trusted doctor or facility that is no longer considered in-network, you may want to find out if there’s an affordable alternative that allows you to continue seeing the providers who know your medical history and make you the most comfortable.
5. Health Care Usage
Information on how often you visit doctors, specialists, and use healthcare services. Consider how frequently you may need care in the coming year.
6. Budget and Financial Information
Your budget for healthcare, including premiums, deductibles, copayments, and out-of-pocket maximums. Compare how different plans will affect your healthcare costs. If your medical or financial situation changed over the past year, it is likely your coverage needs have also changed. You may need a plan that better fits your budget, and reviewing the available options for the upcoming year could reveal a plan that costs less but still meet your needs. Or you may find you are now willing and able to spend more on more robust coverage than your current plan provides.
7. Preferred Plan Features
·Any specific features you want in a plan, such as dental, vision, hearing coverage, wellness programs, or telehealth services. Nearly all Medicare Advantage plans offered dental, vision, and hearing coverage, as well as fitness benefits. Many plans also offer other extra benefits, such as telehealth, over-the-counter benefits, and acupuncture coverage. If your plan does not offer extra benefits that are useful to you, finding one that does could save you money. Or you might find that the extra benefits are more robust on another plan.
Here are two additional considerations that you need to consider prior to enrollment:
1. Questions or Concerns
Put together a list of questions or concerns you have about your current coverage or potential new plans, such as coverage gaps, plan ratings, or customer service experiences.
2. Notes on Past Experiences
Reflect on your experience with your current plan: Are you satisfied with the coverage? Were there any issues with access to care or unexpected costs? Did you receive bills that you did not anticipate? Did you have to change healthcare providers because they were not in the plan’s network?
Whether you receive services through traditional Medicare or through a Medicare Advantage plan, it is important for you to evaluate your overall satisfaction with the product and service.
The Bottom Line: Make sure that you prioritize those areas that have the most impact for your current life situation.
If you have more questions or would like a personal assessment, contact us at info@qsr5.com