Medicare is something we Americans eagerly anticipate most of our lives.
Imagine! All of our medical bills paid for with no muss or fuss.
Until you start to apply. It’s a fairly complex system, and it’s
daunting—even for the most system-savvy person (sure, you aced the
FAFSA forms, but this is entirely different). It pays to educate yourself,
both before applying for the first time as you approach age 65 and also
as the Annual Enrollment Period (AEP) looms,
December 7—that’s when you can make changes to your existing plan.
Changing Plans During Annual Period Enrollment
Again, if you want to make changes to your existing Medicare coverage,
AEP is the time. If you have had a Medicare Advantage plan and your health
or circumstances have changed, you might want to go back to Original Medicare.
If you want to go to a different Medicare Advantage Plan or start with
one for the first time, AEP is your opportunity.
If you are considering any changes, here are five areas to consider:
1. Prescription drug costs
With some prescriptions, you run the risk of ending up in a “coverage
gap” (once known as donut hole), according to Kelly, which means
that if you and your plan have paid up to a certain amount of money for
your prescription(s), after that you have to pay a higher out-of-pocket
until you reach a yearly limit. “If you’re paying a lot for
a brand-name drug,” says Kelly, “you might be able to get
a better deal somewhere else.”
2. Aging or changing lifestyle
“There might be things that will be important to you that were not
when you first signed on to Medicare,” says Kelly. Transportation
to doctor visits, for instance, or a gym membership. (Are you using it?)
“A hearing aid benefit might not be important now,” Straub
adds, “but if you know you might need one soon, keep that in mind
for the future.”
3. Dental insurance
“Most dental plans are not all that great,” Kelly acknowledges,
“With most plans you still pay hundreds of dollars for crowns, etc.
If that’s important to you, check out what’s covered and how
much the fees are.”
4. Alternative and OTC medicine
Plans that offer acupuncture and chiropractic might not be for everyone,
so don’t pay extra for a plan that covers that unless you’ll
use it. And with some you get a credit on over-the-counter medication
purchases such as ibuprofen. “It’s not essential, but it’s
icing on the cake,” says Kelly.
5. What’s the MOOP?
MOOP stands for maximum-out-of-pocket. For instance, if you are getting
chemotherapy and paying 20% (which could easily be over $200 per dose),
you might reach your maximum fairly quickly. After that, insurance pays
100% for your health care. If you anticipate a long-term treatment such
as chemotherapy or surgery that might require an extended recovery or
a stay in a skilled nursing facility, you want to be aware of the MOOP
in any plan you are considering moving to or from. “The MOOP can
change every year depending on your plan,” says Straub.
“Always consider your worst-case scenario,” Kelly counsels.
And Straub says she advises clients, “If you can stay with the plan
you have and be happy, do it because if you change plans every year a
lot can change and you have to fill out new forms for every new doctor.
If you do switch plans you should be aware of how it might affect other
benefits. As agents we take a client through all of their options, keeping
all of their conditions and needs in mind, and show them what might be
a game changer.”
SHOULD WE BE AFRAID?
“If I were a senior these days, I might be getting anxious, wondering
what might change,” Kelly concedes, “especially after getting
an Annual Notice of Coverage (ANOC) or Evidence of Coverage (EOC) letter
in the mail.”
Here’s what Kelly suggests: relax. “In terms of the administration,
they aren’t touching Medicare. Medicare will go on. The ANOC and
EOC letters are required by the federal government; they must go out each
year, and you might see a change of, for instance, an ER co-pay going
from $75 to $100. But that’s usually not enough to get alarmed about.”
That said, Kelly adds that it is important to read that letter to see what’s
happening with your plan. Most will have a minimum of changes—and
those have nothing to do with the current administration. “Most
people won’t have to do anything. You don’t even have to re-register,”
says Kelly. “But the important thing is to look at it, to make sure
there’s nothing dramatic changing.” λ
Questions about Medicare? Contact your health insurance agent. If you do
not have one, call 310-257-7239 for a no cost, no obligation consultation
or visit medicare.gov.
*Rose Straub and Vince Kelly are independent licensed agents and not employed
by Torrance Memorial Medical Center.