Medicare’s Open Enrollment Period (OEP) runs from October 15 to December 7 of each year. The choices made during that time become effective the following January 1, remaining in effect for the coming year. During the OEP, Medicare patients may make changes that can substantially affect the way they receive and pay for medical care.
This topic can become confusing, even scary. The torrents of marketing material received, and the critical importance of this issue lead many seniors to freeze in place and do nothing. This is a mistake; nothing is more important to seniors than getting the very best out of Medicare. Each year, the Medicare OEP should be a time to reevaluate your personal situation and make an intelligent decision.
Advertisements aimed at Medicare patients sometimes cloud this issue. The changes coming to Medicare in 2021 are not great, but this does not mean that seniors should let the enrollment period pass without considering their own circumstances. A senior’s personal health can vary quickly, and the reasons for changing Medicare coverage usually relate to seniors themselves, not to Medicare. A Medicare plan that is suited to a healthy 65-year-old beneficiary will not be adequate for an 80-year-old patient with diabetes or other chronic diseases.
Most people enter the Medicare system at age 65 through “Original Medicare.” As of 2019, two-thirds of all Medicare recipients were still on these two pillars of the system—Part A (hospital coverage) and Part B (doctor and professional services). Parts A and B of Medicare are the bedrocks of senior healthcare, but alone they are not adequate. To fill in the “gaps” in Parts A and B coverage, the private sector insurance industry has developed an array of “Medigap” plans.
A newer option, Part C or Advantage Plans, was added over two decades ago. Actually, Advantage Plans are not a part of anything; they are a complete replacement for Original Medicare and Medigap supplement plans. An Advantage Plan is an entire package, complete onto itself. It will certainly include Parts A and B, and most include Part D benefits for Rx drugs (see below). From the senior’s view, there are some key differences between Original Medicare and Advantage Medicare.
The annual out-of-pocket expenses a senior may pay are limited by Advantage-type plans. Parts A and B of Original Medicare do not limit these expenses and force seniors to buy supplemental Medigap coverage. On the other hand, Advantage Plans force beneficiaries into a network of medical professionals and penalize seniors who go out-of-network for care. The best plan for any given senior may vary with changing health or changes in the plans. The Open Enrollment Period is the time to consider these possible changes. Here are some things to consider.
- Are you spending too much out of pocket for health care? Original Medicare and its Medigap supplements may have been adequate in the past, but as you have aged, the coverage has not kept pace. This may be especially true if you have developed a chronic condition. Medicare Special Needs Programs (SNPs) are a type of Advantage Plan aimed at specific groups. They adapt their networks, benefits and drug formularies to fit these patients.
- Do your doctors and pharmacies still accept your current plan? The members of provider networks can change from time to time. Check your preferred providers to be sure they continue to honor your insurance.
- Compare what you are getting from a Medigap letter plan to the benefits offered by Advantage options. Advantage Plans are the best reason to look at your coverage. Any senior qualified for Medicare insurance is qualified for an Advantage Plan.
- Consider extras offered by some Advantage Plans. These may include anything from gym membership to yoga lessons. COVID-19 has reduced the attractiveness of some Advantage extras, but this pandemic will not last forever.
- Are you taking medications that are not covered? The newest member of the Medicare family is Part D, Rx drug coverage. This has been a boon to seniors, but also the cause of confusion. Drug formularies change from time to time. If you are taking an expensive drug, look for the stand-alone Plan D or Advantage Plan that has the best coverage.
Many of these situations are best handled by an experienced professional who knows the local conditions, networks and available plans. Contact our Approved Vendors, CMD Insurance Agency at 386-217-3039 or United Healthcare at 386-243-9993. Each with over 25 years of experience in the industry. Please click on their link to find out more.