Medicare open enrollment begins soon. Why should you be careful

Of course, there are probably more fun things to do than review your Medicare coverage.

However, it is that time of year. Open registration, which starts October 15 and ends December 7, is when you can make changes that go into effect on January 1. check the least to see if your current plan remains your best option, experts say.

“Providers can opt for or withdraw from a network plan, or the cost of a prescription drug may be higher or lower, or may no longer be covered,” said Elizabeth Gavino, Founder of Lewin & Gavino and Independent Broker and General Agent of Health Insurance Schemes.

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Simply put, this annual fall enrollment period is used to add or change coverage related to an Advantage plan (Medicare, Part C) and / or prescription drugs (Part D). You can change, add or remove these parts of your coverage.

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

“It’s concerning knowing what we know about the changes made from year to year,” Cubanski said. “Even if you’re happy with your plan, it’s worth taking a little time to see if you find a plan with better value or better coverage for your needs. “

Additionally, be aware that while congressional lawmakers are debating whether to add dental, vision, and hearing coverage to the original Medicare, there is no certainty that the provisions will pass through. comprehensive legislative process. And if you have an Advantage plan, you may already have some coverage for these benefits.

Here’s what you need to know about open registration.

About 63.3 million people are covered by Medicare. The majority of them – 55.1 million – are 65 years of age or older, while the rest are people with permanent disabilities.

Fall registration is different from your initial registration window, which begins three months before your 65th birthday and ends three months after. This is when you usually need to sign up for Part A (outpatient care) and Part B (outpatient care) unless you encounter an exception such as having acceptable coverage elsewhere. You can also enroll in an Advantage plan or a Part D drug plan (both offered by private insurers) during your initial enrollment period.

Nonetheless, the enrollment opened in the fall affects most beneficiaries in one way or another because of the coverage they choose. For example, 26.7 million people choose to receive their Part A and B benefits through Advantage plans, which will likely include Part D.

The rest stick to the original Medicare (parts A and B) and often combine it with a stand-alone Part D plan. Some also benefit from a supplemental Medicare plan (aka Medigap), offered by private insurers.

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

Each year, usually before September 30, your Advantage plan or drug plan should send you a package explaining the changes for the coming year.

This could include adjustments to monthly premiums, co-payments, deductibles, coinsurance or maximum disbursement limit, or changes in drug coverage, said Danielle Roberts, co-founder of Boomer Insurance Company. 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 2022 average monthly premium for Part D coverage will be $ 33, up from $ 31.47 this year.

Monthly Part B bonuses – along with other cost details – for 2022 have yet to be finalized. However, the standard Part B premium is expected to drop from $ 148.50 to $ 158.50 this year, according to the latest report from Medicare administrators.

Be aware that some Part D shots are bent, Roberts said.

“If you are enrolled in a drug plan that is being canceled, it is likely that your insurance company [move you] to one of their 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 stand-alone Part D drug plan,” Roberts said.

The same goes for finding out too late that your medications are not covered or that they cost significantly more.

However, if you choose an Advantage plan when you register in the fall and later find that it is not for you, you can change your coverage between January 1 and March 31. You could switch to another Advantage plan or to original Medicare and a stand-alone prescription plan.

Although insurers offering Advantage plans are federally 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 care or come without a premium (although you would still pay your Part B premium).

It’s important not to just focus on that monthly amount, said Cubanski, of the Kaiser Foundation.

“People may want to be careful what a plan charges for hospitalization or skilled nursing facilities,” she said. “Even if you don’t think you need to be hospitalized, it’s worth figuring out how much you would pay out of pocket if something happened.”

Unlike the original Medicare, there are limits that are chargeable to customers with Advantage plans, so you know what your worst case scenario would be. These limits, however, can differ from plan to plan, as can deductibles and other cost sharing.

Plus, make sure your preferred doctors, hospitals, or other providers are still participating in the plan network. And assuming the plan covers prescription drugs (most do), make sure any prescriptions you take are still covered.

If your Advantage plan isn’t working for you and you want to remove it completely instead of switching to a new one, you can do so.

You would just be left with the original Medicare (Parts A and B) and you would need a stand-alone Part D drug plan if you want this coverage. (If you don’t, and change your mind later, you could face a financial penalty for doing without.)

Additionally, although beneficiaries in this situation may want to purchase a Medigap policy, there are rules that apply to enrolling in a policy. Typically, unless you live in a state with different rules or you have an exception, you have a six-month window when you first sign up for Part B to purchase Medigap without having to answer health questions and be penalized for pre-existing conditions.

If an underwriting does occur, it is wise to take out the Medigap policy at the start of this fall enrollment window and hold onto your Advantage plan until you know you can get the additional coverage, said. Roberts.