As you can probably tell by the overwhelming health insurance ad campaigns, the Medicare Open Enrollment Period is just around the corner – October 15 to December 7*.
Before this annual window, when you can make Medicare plan changes, it’s wise to review your current Medicare plan and decide if it’s still the best option for you. You may find that there’s a better plan, or combination of plans, to provide you with more beneficial coverage.
You can look for an independent, no-cost consultant to advise you in this process.
There’s Much to Consider
- The growing number of options within the Medicare framework:
- Medicare A & B – Original Medicare
- Medicare C – Advantage Plans
- Medicare D – drug coverage
- Medigap – supplemental coverage
- The cost of Medicare and supplemental plans
- Possible changes in your health status
- Your level of income
What Options Does Medicare offer?
Original Medicare – A (Hospital Insurance) & B (Medical Insurance)
Most of our clients have chosen Original Medicare A (Hospital Insurance) & B (Medical Insurance) plans along with Medigap (Supplemental Insurance), plus Medicare D (Prescription Plan). They prefer the flexibility of coverage provided by Medicare A & B and want to avoid the in-network and geographic coverage limitations found in Medicare C (Medicare Advantage) plans.
Medicare Advantage – C
A few of our clients have chosen Medicare Advantage coverage because some plans provide dental, vision, hearing, wellness services, etc., which Original Medicare does not. In addition, the plans usually include prescription coverage, premiums are usually lower or non-existent, and there is no need for a supplemental insurance plan.
Other clients whose coverage had been subsidized by their former employers have recently switched to Medicare Advantage plans. They’ve been encouraged by their pension plans (from public and private employers) to accept the lower premium plans because prior subsidies for other Medicare options were eliminated. Learn more in our article on Medicare Advantage offered through pensions.
What to Consider in Reviewing Your Current Medicare Plan
Original Medicare, coupled with a Medigap supplemental insurance plan, is typically considered more expensive than Medicare Advantage. However, when comparing plans, you need to factor in all medical costs.
Before Medicare Open Enrollment, take stock of the potential costs of health insurance choices:
- Examine the cost of premiums, co-pays, and income-associated Medicare surcharges (IRMAA). Learn more in our article about IRMAA.
- Also, review the deductibles for medical and drug coverage associated with the plan(s).
- Factor in the cost of medical providers and services (for example, dental and vision) that do not accept any Medicare insurance.
Access to Medical Services
Original Medicare, coupled with a Medigap supplemental insurance plan, is typically considered to have advantages in access and flexibility of medical care compared with Medicare Advantage.
Start with these basic questions:
- Who are your preferred medical providers – doctors, clinics/medical centers, hospitals? Also, list dental, hearing, vision, and other specialty providers.
- Do your providers accept Medicare? If so, what types?
- Are the procedures you need covered under your Medicare plan(s)?
- What medications do you take – dosages and quantities? Are there generic versions of these drugs available?
- Do you frequently travel away from your medical service area?
If don’t need many services through a more expensive Medicare plan with supplemental insurance, you might choose an Advantage Plan.
Medicare Advantage may be beneficial if:
- You are healthy and only need routine medical visits.
- Your preferred doctors don’t accept Medicare, and you are prepared to pay out-of-pocket.
- You don’t take high-priced drugs.
With your answers to the questions above, consider if a low-cost Medicare Advantage plan could work for you as a kind of catastrophe plan.
Ease of Switching Medicare Plans
If your health status changes, you can switch to a different Medicare Advantage plan or convert to Original Medicare with supplemental coverage during the Medicare Advantage Open Enrollment Period – January 1 to March 31*. There is no medical underwriting, so there are no evaluation or eligibility requirements for opting for Original Medicare’s more flexible coverage during Medicare Open Enrollment.
Reviewing Part D Plans
If, after your analysis, you choose to remain with Medicare A & B, then you need to review your Medicare D (prescription) plan. You’ll need to consider the overall cost of the drugs you take – the total of the premium and the co-pays.
The best way to choose a prescription insurance plan is to follow these steps:
- Develop a list of your prescriptions, identifying drug names, dosages, and frequencies.
- Compare your list to drugs covered in the Medicare D formulary.
- Assuming at least some of your prescriptions are on the formulary, check the premium costs and co-pays of your prescriptions, as well as participating pharmacies. If none of your prescriptions are covered under the various Medicare D plans, then choose the lowest-priced plan.
- Ask the pharmacist at your preferred/convenient location to help you find the most cost-effective Medicare D plan based on that pharmacy’s pricing.
- Once you’ve signed up with Medicare.gov, use Medicare’s prescription drug coverage tool to compare plans and enroll in a drug plan.
- Work with an independent consultant or contact your local State Health Insurance Assistance Program to find the most cost-effective plan for you.
- Keep in mind that, if you want your drugs presorted and prepackaged in blister packs to aid in managing doses, then choosing a pharmacy providing this service may be the deciding factor in choosing a plan vs. the pricing of your prescriptions. (Not all retail pharmacies provide this service, but it is common through online pharmacies.)
The myriad of Medicare options and regulations can be confusing and overwhelming. Work through your review carefully and consider seeking help for some reassurance in making decisions and selections.