Here is a checklist to help you make the best choices.
If you are a current Medicare recipient, you may know that every October
you have the option to change your coverage during the Fall Open Enrollment
Period (also referred to as the Annual Enrollment Period). This provides
you the opportunity to review your current benefits and how they may change
in the coming year, according to independent insurance agent Vince Kelly.
Here’s a checklist to get you prepared for open enrollment.
Are you ready for open enrollment?
The enrollment period for 2022, as in prior years, runs from October 15
to December 7. You can make as many changes as you wish, but your final
selections submitted by December 7 will stand as your new plan and will
start on January 1, 2022. If you don’t make any changes, your current
plan will simply continue with any new benefit changes for 2022.
From January 1 through March 31, 2022, there is also a Medicare Advantage
Open Enrollment Period during which people in a Medicare Advantage Plan
may make one change, which in turn will remain for the year. Kelly says
this is unless you qualify for a Special Enrollment Period (SEP), in which
case you may make a change during certain times of the year. One popular
example of an SEP is moving out of the service area.
Have you reviewed your plan notices?
Pay attention to your mail. As early as September 15, Medicare Advantage
recipients will be receiving their Annual Notification of Change (ANOC)
pamphlet from their current insurance company. The ANOC shows if the plan
you currently have is changing, such as moving a prescription drug to
a higher tier (which could make it more expensive) or adding benefits.
It pays to compare. “Most people don’t make any changes,”
Kelly says, “and some see the pamphlet and get overwhelmed.”
But they shouldn’t—all you really need to do is read the chart
comparing the 2021 and 2022 columns. Confirm the benefits you like and
had in the past year will continue next year. If you’re happy with
your current doctors, your health plan benefits and your coverage, open
the ANOC and check for any changes between your 2021 benefits and the
upcoming 2022 benefits.
Does your existing plan meet next year’s needs?
During this enrollment period you may change or join a Medicare Advantage
HMO plan. The benefits of these plans are wide and varied. Some of the
most important factors are Medicare Advantage plans typically include
a Part D prescription drug plan, urgent care visits and low or no copays
If you are currently not in a Medicare Advantage HMO, you can join during
the Medicare Annual Enrollment Period. You also have the option to change
your stand-alone Part D prescription drug plan during Medicare Annual
Enrollment Period only (unless you qualify for an SEP as noted previously).
You may need a supplement plan. Individuals who decide to pay a premium
and join a stand-alone Part D plan will return to their Original Medicare
and should consider applying for and purchasing a Medicare Supplement
insurance (also known as Medi-Gap). A Medicare Supplement policy helps
pay the 20% not covered by Original Medicare.
Is this your first time enrolling?
If you are a first-time Medicare applicant, your Initial Enrollment Period
(IEP) is the seven-month period surrounding the month you turn 65—three
months before the month in which you turn 65, the month of your birthday
and the three months following your 65th birthday. Once you’re eligible
to apply, you have the choice of Original Medicare (the fee-for-service
program run by the U.S. government) or a Medicare Advantage plan (a type
of private insurance offering an HMO).
Do you need Medicare supplement insurance?
Medicare Part A and Part B are considered Original Medicare and by design
cover only basic services. Also, there is a high hospital copayment charge
with both. This is why consumers should consider adding a Medicare Supplement
insurance plan to help cover costs not covered by Original Medicare.
The best time to get a Medicare Supplement plan is when you are new to
Medicare because the premiums based on age and inflation will be the lowest.
Also, if you apply when you are first eligible, an insurance company can’t
deny you a policy or place conditions on it. These situations include
pre-existing conditions (they can’t deny you or charge you more)
and moving or travel. “A supplement will also give you more control
and freedom of choice,” adds Kelly.
Make sure you understand your options:
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility,
hospice and some in-home health care. For most people, Medicare Part A
has a $0 monthly cost because of what they have paid into Social Security taxes.
Medicare Part B (Medical Insurance)
Part B covers certain doctor’s services, outpatient care, medical
supplies and preventative services. For most services, Part B covers 80%
of charges with no out-of-pocket maximum. There is a monthly cost for
Part B, which is based on your income. For some, the state will subsidize,
while high-income earners will pay more. Details can be found on the official
Medicare Part C (Medicare Advantage Plans)
Medicare Advantage plans are offered by private insurance companies contracted
by Medicare and include HMOs. Medicare Advantage plans cover everything
Original Medicare Parts A and B do and also offer prescription drug coverage,
routine eye care, transportation and often acupuncture and other integrative
treatments. Many also offer perks such as gym membership, dental discounts
and allowance for over-the-counter items such as toothpaste, vitamins
and skin care products. In addition, they offer several options for you
to choose a medical group or an independent practice association (IPA)
contracted with them, such as Torrance Memorial IPA, a division of Torrance
Memorial. For information about Medicare Advantage Plans, you can attend
Torrance Memorial IPA’s virtual Medicare 101 educational events. Visit
TorranceMemorialIPA.org/medicare101 to register.
These plans offer optimal coverage for just about anything that might arise
in your life. There is great coordination of care within your IPA caregivers,
and you can change your plan every year according to your needs.
Medicare Advantage Plans require you to choose an insurance company (such
as Aetna, Anthem Blue Cross, Blue Shield of CA, Health Net, Humana, SCAN
or AARP/United Healthcare) and a medical group such as nonprofit Torrance
Memorial IPA. The insurance companies, in turn, are contracted with the
IPAs so you have plenty of choices. Torrance Memorial IPA contracts with
the HMO insurance companies listed above.
For more information, go to medicare.gov; call the Torrance Memorial IPA
Resource Center at 310-257-7239; call Health Insurance Counseling and
Advocacy (HICAP) expert Doris Herzog at 310-517-4666; or attend Torrance
Memorial IPA’s complimentary Medicare 101 lectures. Visit TorranceMemorialIPA.org/medicare101
for more info.