It’s Open Enrollment Time. It Can Be Daunting. There is Help.
Written by John Ferrari
It’s Annual Medicare Enrollment Period (also called Open Enrollment),
which runs from October 15 to December 7 every year. During this period
you can evaluate your own Medicare Advantage (aka Part C) and/or Part
D prescription drug plans and compare them to all the other plans on the
market. If you find a plan that better fits your needs, you can switch
to that Medicare Advantage and/or Part D plan. Additionally, if you have
Original Medicare (Parts A and B) you can join or drop a Part D prescription
drug plan or switch from Original Medicare to a Medicare Advantage plan;
you also can switch from a Medicare Advantage plan to Original Medicare.
That’s a lot to consider—and you should. Each year, insurance
companies can make changes to their plans, potentially affecting your
medical and prescription drug coverage, provider and pharmacy networks,
and payments, including monthly premiums, deductibles and drug costs.
Changes take effect on January 1; insurance companies must announce any
upcoming changes before the open enrollment period, giving you time to
examine what’s going to change in your plan and compare it to other
plans available. You may find your current plan is the best for you, but
you may also find a plan offered by another insurance provider offers
you better or less expensive coverage.
Comparing medical insurance plans may not be exciting (or easy), but help
is available. There are five key sources of information you can use to
make sense of your coverage, other plans that may be available to you
and any upcoming changes.
The first two are the government’s annually updated Medicare &
You handbook, and the website Medicare.gov. The handbook is available
in print and online (search for Medicare and You 2020). It lists plans
and their associated premiums, copays, out-of-pockets maximums, prescription
drug costs and other information. “It’s a really great place
to start,” says independent health insurance agent Rose Straub.
Plan benefits are all more similar than they are different, she adds,
but the differences can be important; Medicare & You makes it easier
to compare plans.
Medicare.gov presents much of the information found in Medicare & You,
as well as handy tools including searching for and comparing doctors and
other health care providers, hospitals, inpatient rehabilitation facilities,
nursing homes, dialysis facilities and other medical services that accept Medicare.
“One of the biggest things to look at is medicine,” Straub
says. “It’s really important to look up the medicines you’re
taking.” There can be significant differences in prescription drug
coverage between plans, for brand name medicines, insulin, oral cancer
medications or inhalers. Based on differences in drug coverage alone,
Straub says, you may be able to narrow a choice of eight plans down to
two or three—those that provide the best coverage for the medications
you take. Medicare.gov allows you to enter the medicines you take and
find out which HMOs cover them, and which prescription drug plan works
best for your combination. The handbook also lists, for example, the vision
and hearing benefits of each plan, which can make a big difference if
you wear glasses or hearing aids.
The booklet and website both provide useful information including how to
sign up for a plan and how Medicare and other medical insurance coverage
work together. And when you’re ready, you can enroll in Medicare
on Medicare.gov (or call Straub or Kelly for assistance).
A third resource is your insurance provider’s Annual Notice of Change
(ANOC) pamphlet. Your current insurance provider must send you an ANOC
pamphlet by September 30 each year. The pamphlet presents the plan’s
current costs and costs for the upcoming year side by side, so it’s
easy to compare the two. With this information you can see what’s
going to change, compare your current plan to other available plans and
choose whether you want to keep your current coverage or change your plan,
all before Medicare’s open enrollment period begins on October 15.
The last two resources are more individualized: trusted licensed insurance
advisors or brokers and your medical group. Insurance advisors like Straub
and Kelly help clients navigate their Medicare options and weigh variables
including medical needs, plan costs and plan coverage. Because independent
agents represent all insurance companies, Kelly explains, they are unbiased
and can objectively compare different plans and costs.
“We just want you to be happy and incur the least costs,” he
says. “You can’t always keep it simple with all these rules.
We can focus on what you want, what you need and what’s going to
work best for you.” For example, Medicare Advantage plans save money
but limit your choice of doctors. Medigap plans, on the other hand, give
people greater choice, but at the expense of higher monthly premiums.
“It’s such an individual choice,” he says.
Your medical group—whether affiliated with Torrance Memorial Medical
Center, another medical center or a separate provider—can provide
additional information, the most basic being whether the group works with
Medicare and what insurance plans it works with. Torrance Memorial also
offers an overview of Medicare: Medicare 101, led by Straub and Kelly,
usually takes place on the fourth Wednesday of each month at the Hoffman
Health Conference Center. Kelly emphasizes that your needs are individual;
the best Medicare and prescription drug plans for someone else (even your
spouse) may not be the best plans for you. Re-evaluating your health care
coverage every fall may take some time, but it can save you money and
ensure you have the best coverage as your medical needs change. And there
is good news: Kelly says there aren’t any big changes planned for
Medicare next year.
For information on upcoming Medicare 101 seminars, visit
Thipa.org/Medicare101 for specific dates and times. Or contact an agent, such as
Vince Kelly, 310-625-1837, or
Rose Straub, 310-715-2300 for a free consultation. Or make an appointment for free
Medicare counseling with a health counseling and advocacy expert, call
Doris Herzog at 310-517-4666. Sessions are held on Thursdays.