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Medicare Open Enrollment:

A Few Pointers

  MAKE THE PROCESS EASIER  

Older or disabled Americans with Medicare coverage have probably noticed their mail boxes turning into a central storage center for solicitations from health insurance companies, not to mention persistent and questionable TV ads, which can mean only one thing:

It’s time for the annual Medicare open enrollment.

Most beneficiaries have from Oct. 15 through Dec. 7 to decide which private insurance company Part C or Part D plans offer the best coverage for 2021.

Some tips for the novice and reminders for those who have been here before can make the process a little easier.

Pay Attention to the Mail

If a person is presently enrolled in a Medicare Part C (Advantage) or stand-alone Part D prescription plan, they should carefully read the “annual notice of change” or “evidence of benefits” documents from the insurer.

These required documents highlight the costs and benefit changes to be followed for next year. Ask the insurer for another copy if the booklets are not received.

“Some people just tend to discard these documents, but it’s really important to read the information for expected changes,” says Ernie Bobel, Jr., principal adviser of EHB Insurance Group.

Choosing Traditional Medicare or Medicare Part C 

The open enrollment period is an opportunity to switch plans, including moving between the government-run traditional Medicare program and a Medicare Part C (Advantage) plan.

Medicare Part C (Advantage) plans are offered by private insurers, which receive payments from the federal government to help cover the costs for beneficiaries. However, these plans restrict members to their network of doctors, hospitals and a formulary (list) of covered drugs.

With some rare exceptions, a person cannot leave the plans midyear — even if the plans drop drugs from the formulary or the hospitals, physician specialists or medical equipment suppliers leave the plan.

Some Medicare Part C (Advantage) plans cover dental, hearing and vision care, and they cap the "necessary medical out-of-pocket expenses" up to $7200 per calendar year; not including premiums, Rx drugs, unapproved and out-of-network services.

Once that limit is reached, the insurer pays the covered services for the remainder of the calendar year. But details of these plans — such as the caps on member spending, the premium prices and service areas — can change from year to year.



On the other hand, with traditional Medicare, patients can go to any provider who participates in the program. Because there is no limit on the cost-sharing of medical expenses beneficiaries pay, most individuals purchase “Medigap” supplemental policies or have other insurance to lower those costs.

Check The Plan’s Network

If choosing a Medicare Part C (Advantage), contact the doctors, hospitals and other providers directly to find out if they are in the plan’s network.

Be sure to give the provider's office the plan’s full name, not just the name of the insurance company since insurers offer multiple plans that may have similar names, says Gina Upchurch, executive director of Senior PharmAssist in Durham, N.C.

If the plan’s code numbers are known they can help the office administrator.

Confirm Where The Drugs Are Available 

When choosing a prescription drug plan, also known as Medicare Part D, the total annual costs are most important. Consider factors beyond the premiums. A person may pay different amounts when the plan first begins each year than when a person reaches the coverage gap. 

Find out whether the lowest price is available at a favorite pharmacy or if traveling elsewhere to get that price. Most plans offer their lowest prices only at their preferred, in-network pharmacies.

Also, ask what other restrictions apply. For example, is prior authorization required and step therapy needed?Also, will the cost vary depending on the frequency taken and/or quantity of the prescription? 

“A person can save thousands of dollars just by switching pharmacies,” says Ernie Bobel, Jr., principal adviser of EHB Insurance Group. 

That’s because drug plan prices can depend on whether a drugstore is a preferred pharmacy within the plan’s network. Ernie has helped many seniors reduce their annual prescription drug bill after simply changing pharmacies.

What About Qualifying For A Subsidy?

Low-income people can qualify for the “extra help” subsidy that pays for the premiums of certain drug plans and other costs. They may also be eligible for assistance to reduce their share of medical costs in traditional Medicare. Premiums and subsidy amounts can change each year, so if a person already has a subsidy they should confirm that it is enough to cover the plan’s premium next year. Otherwise, a person could receive a surprise bill for the difference.

Check The Calendar 

There’s a lot to consider and only seven weeks to complete. And remember, this enrollment period is different from the Affordable Care Act’s marketplace enrollment, which begins Nov. 1 and lasts through Dec. 15.

Still, studies have shown that most Medicare beneficiaries do not switch plans. People are likely to stay with whatever plan they presently have because they shy away from making a change.

  

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