Written by John Ferrari
Autumn is almost here, and the season also ushers in Medicare’s annual
Open Enrollment Period. It may not be the most anticipated tradition of
the season, but it can save you money and optimize your health care coverage
for the coming year. It’s worth taking time to review your Medicare
plans and look for any changes that may affect your coverage or costs.
Advantage spoke with licensed health insurance agents Vince Kelly and Rose
Straub about some of the top questions Medicare beneficiaries have about
the Open Enrollment Period and what to look for.
When is the Open Enrollment Period?
Each year, Medicare’s Open Enrollment Period runs from October 15
to December 7. During this period, you can join, switch or drop a Medicare
health plan or Medicare Advantage plan. You can change from Original Medicare
(Parts A and B) to a Medicare Advantage plan (Part C), or switch from
Medicare Advantage back to Original Medicare. You can also join, switch
or drop Medicare drug coverage plans (Part D). Any changes you make take
effect on January 1.
Is this the only time I can change my Medicare plan?
There is a separate enrollment period just for Medicare Advantage, from
January 1 through March 31. You can switch between Advantage plans or
end your Advantage coverage and return to Original Medicare. However,
you cannot switch from Original Medicare to a Medicare Advantage plan.
Additionally, some life events trigger Special Enrollment Periods—for
example, when you lose your current coverage or become eligible for Medi-Cal,
move to a new coverage area or move into or out of a skilled nursing facility,
long-term care hospital or similar facility.
The amount of information can be daunting. Is there any way I can quickly
see what’s going to change?
Each year the government mails an updated Medicare and You handbook to
Medicare beneficiaries in late September or early October. “The
inside front cover has a list of what’s new—it’s very
useful,” Straub says. Medicare and You is also available online
The handbook has a lot of general information. How can I see what’s
going to change just in my Medicare plans?
In late September, Kelly says, you should receive a separate notice detailing
how your specific plans will change in the upcoming year.
Is there any way I can easily compare plans and find what’s best for me?
Yes! Create an account on the medicare.gov website, and you’ll have
access to Medicare Plan Finder—a tool that can help you find, compare
and enroll in a new Medicare Advantage or drug plan in your area. Plan
Finder can show you how different plans will affect coverage and costs
for any prescription drugs you use, Kelly says.
What about the infamous Part D “donut hole” in drug coverage?
“The donut hole is now called the coverage gap, but it’s the
same thing,” Kelly explains.
“It has not gone away,” Straub agrees. “If you reach
the coverage gap, instead of paying 100% for the cost of brand-name drugs,
now you’ll pay 25%. The coverage gap affects about 10% of Medicare
What other costs should I look out for?
“More and more people are falling into the high-income bracket,”
Kelly says. “That means more people are paying more for the Part
B premium. You should receive a letter from Social Security in November
or December explaining what your deductible will be.”
How can I lower my Medicare costs?
“The easiest way is to join a Medicare Advantage HMO program,”
Kelly says. “You must use certain doctors, but you may be pleasantly
surprised to see what doctors are available.” Locally, that includes
primary care and specialty physicians in the Torrance Memorial IPA network
What trends in Medicare coverage and service should I be aware of?
Kelly and Straub note Medicare insurance has become very competitive. Many
Medicare Advantage plans now offer extra perks such as transportation
to medical appointments, discounts on dental care, basic vision care or
coverage for acupuncture and routine chiropractic treatment—all
items not normally included in Original Medicare. However, to make up
for the costs of those perks, plans may also have higher co-pays for other services.
Another trend is the increasing use of call centers as a way for insurance
providers to enroll more customers. “These call centers typically
use newer, inexperienced agents,” Kelly says, adding that agents
calling from an out-of-area call center may not be familiar with the medical
networks, physicians and other health care providers in your area. “Local
agents are familiar with doctors and medical groups, and that’s
important in making a good choice.”
“Know your agent!” Straub says. “Use local resources—people
who know your local options. The most important consideration when choosing
a plan is your doctors. The insurance plan is almost secondary. It’s
the doctors who make people happy.”
Beware of insurance agencies who use celebrity spokespeople to endorse
their products. While these hotlines may seem official, they are not,
Kelly says. Callers hoping to get information from an official Medicare
source instead are connected to a high-pressure insurance salesperson.
Once you call, your information is in the company’s database, and
during the Open Enrollment Period you may find yourself “continually
harassed with phone calls from the many call centers located around the
country,” Kelly says. You can always contact your local Health Insurance
Counseling and Advocacy expert.
What’s the bottom line—how much time should I spend reviewing
my Medicare coverage during the open enrollment period?
“Plan changes typically are minor,” Kelly says. “In general,
if you are happy with your plan, there’s no reason to change. It’s
likely you will be happy with your coverage next year.”
But, Straub says, a change can mean a significant increase in expenses
for individuals using an expensive medication, if that change affects
drug costs. Also, deductibles are always increasing—especially for
Part B coverage—and that’s certainly worth knowing.
Bottom line: Whether it takes 15 minutes or a few hours, review your plan
this fall and get ready for the new year. It’s an early resolution
you’ll be glad you kept.