Andreswd | E+ | Getty Images
Medicare beneficiaries have until Dec. 7 to change their Medicare health and prescription drug coverage for the coming year through open annual enrollment.
This year, there’s even more reason to pay attention, as financial assistance for prescription drug coverage is set to expand starting Jan. 1, according to Meena Seshamani, director of the Center for Medicare at the Centers for Medicare and Medicaid Services.
“It is important for people to check and see if they could be eligible for financial assistance to help pay for premiums, to pay for co-pays,” Seshamani said.
Starting in 2024, people who face high prescription drug costs will not have to pay anything out of pocket once they hit the catastrophic phase of their benefits, she noted, thanks to new prescription drug legislation.
Notably, Medicare beneficiaries who take insulin currently do not have to pay more than $35 per month for covered prescriptions. They can also access recommended vaccines at no out-of-pocket cost, Seshamani noted.
There are other reasons why Medicare beneficiaries should pay attention to the annual enrollment period this year.
“Medicare open enrollment is so important because options change every year, and people’s health needs and their financial situation changes every year,” Seshamani said.
For beneficiaries, this is an opportunity to save.
“You’re never locked in for longer than 12 months,” said Darren Hotton, associate director for community health and benefits at the National Council on Aging, an advocacy group for older Americans.
Here are answers to some top questions to help you navigate Medicare annual open enrollment this year.
What is Medicare annual open enrollment?
Medicare open enrollment is when beneficiaries can shop around for health plans or prescription drug coverage that better meet their needs.
Notably, health and drug plans make changes every year, so experts say it’s wise to revisit your selections to see which plans match your needs when it comes to cost and coverage, as well as the providers and pharmacies that are in network.
Beneficiaries may be able to switch from original Medicare, which is managed by the federal government, to a Medicare Advantage plan that is privately managed, or vice versa. Alternatively, they may switch Medicare Advantage plans, Hotton noted.
Original Medicare includes Medicare Parts A and B. Medicare Part A covers care provided by hospitals, skilled nursing facilities and hospice, as well as some home health care. Medicare Part B covers doctors’ services, outpatient care, medical supplies and preventive services.
You just can’t ever come into Medicare anymore and say, ‘I’m done. I pick something and I’m done,’ because that’s always the wrong thing to do.
Darren Hotton
associate director for community health and benefits at the National Council on Aging
Beneficiaries on original Medicare may choose to add prescription drug coverage by signing up for a Medicare Part D plan, or additional coverage for out-of-pocket costs through Medicare Supplement Insurance, or Medigap.
Alternatively, beneficiaries may choose a private Medicare Advantage Plan, which provides Medicare Parts A and B, and may also include vision, dental, hearing and prescription drug coverage.
“You just can’t ever come into Medicare anymore and say, ‘I’m done. I pick something and I’m done,’ because that’s always the wrong thing to do,” Hotton said.
“You need to decide which option is best for you,” he said.
That starts by asking yourself whether you want Medicare with Medicare supplement coverage like your parents had, or whether you want coverage like what an employer might provide, Hotton said.
What should I consider when assessing options?
Much of the decision comes down to coverage and costs. For example, often people will change plans to save on premiums, according to Hotton.
The decision also depends on what you personally need when it comes to your care — the doctors or care networks you prefer, the prescriptions you want covered and the pharmacy where you typically have those filled.
“Even if you’re happy with the plan that you’re in, there could be a better option for you,” Seshamani said.
There may be new choices for you this year, she noted, particularly as the new drug law goes into effect. Moreover, you may be eligible for financial assistance.
“It is very important for everyone to evaluate their options every year, because options change, your health can change and your financial situation can change,” Seshamani said.
Where should I go for advice?
Catherine Falls Commercial | Moment | Getty Images
To get the best advice, experts recommend consulting trusted sources.
Beneficiaries may consult directly with the agency through Medicare.gov and 1-800-MEDICARE, according to Seshamani.
There’s also local unbiased help available through the State Health Insurance Assistance Program, or SHIP, through ShipHelp.org.
By making an appointment with your local SHIP office, you can have a counselor help identify the best plans for you for the coming year, according to Hotton, a former SHIP director for the state of Utah. This may be done in person, over the phone or virtually. The entire process may take just 30 to 40 minutes, he said.
What are red flags to watch out for?
A lot of advertisements pop up during open enrollment season. Unfortunately, that may also include misleading marketing practices, according to Seshamani.
It helps to double-check whether your personal providers and prescriptions may be covered under a certain plan, and how they compare to other offerings, via Medicare.gov or your local SHIP office through ShipHelp.org.
What mistakes should I avoid?
When shopping for Medicare coverage, it helps to make sure you are getting the best advice.
Double check what any advertisements or sales brochures tell you with your own research through Medicare or SHIP.
Also be wary of who you take advice from, Hotton said.
“What you don’t want to do is just jump into a Medicare Advantage plan because your friend says they like it,” Hotton said.
It also helps to double check whether the coverage you want may be available for less elsewhere, he said.
“You’re paying the premium, you want to make sure you get really good coverage,” Hotton said.
How soon should I act?
Medicare’s enrollment period began Oct. 15. While open enrollment will last until Dec. 7, it helps to act sooner rather than later.
“People should not wait,” Seshamani said.
“If you miss the Dec. 7 deadline, then you have to wait until next open enrollment and you may miss a chance to save money or get better health care for you,” she said.
