It’s that time of year again: raking leaves, pulling out scarves and sweaters, enjoying cider mill donuts, and looking over your Medicare plan to make sure it’s working for you. If that last one isn’t on your fall to-do list, it should be. Thinking about health insurance may not be your idea of autumn fun, but you’ll be glad you did it when you find better coverage or lower costs. A Medicare checklist can help you get started to make sure nothing slips through the cracks. Open enrollment, also called the annual enrollment period or annual election period (AEP) is from October 15 to December 7 for coverage beginning January 1, 2022.
What can you do during Medicare open enrollment? Now is the time to:
If you don’t do anything during the open enrollment period, you will have the same plan in 2022 as you did in 2021 (although there may be changes to the plan itself). How do you know which plan to switch to, or even whether you should change plans at all? It all begins with your Annual Notice of Change (ANOC) letter.
There’s a good chance that you have already received your ANOC letter. Medicare plans send the letter out in early October, and Medicare Advantage plans usually send them in September.
There’s a good chance that you have already received your ANOC letter. Medicare plans send the letter out in early October, and Medicare Advantage plans usually send them in September. The ANOC is important because it summarizes and explains any changes in costs, coverage, or the service area for the upcoming year. It’s important to review your ANOC even if you like your existing plan, because your existing plan may not be exactly the same next year.
For example, if your current plan is dropping your doctor from its network, or a drug you need from its formulary (list of covered medications), you may want to think about switching to another plan which allows you to remain with your doctor or keep coverage for needed medication. Similarly, if the premium for your existing plan is going up significantly, you may want to look around for a better deal.
Once you understand the changes to your existing plan, you will be in a better position to compare plans to see if you want to change.
It can be hard to know where to begin when comparing plans. In general, you should consider these four aspects of any plans you are looking at:
Naturally, you will want to pay close attention to the premium for the plans that you are looking at. If you like your own plan has increased drastically, it may no longer be the best option for you. Obviously, the premium isn’t the only thing that goes into the cost of the plan. If the deductible or co-payment for your plan has increased, you will be paying more out of pocket.
If you are like most seniors, you are on at least one regular medication, and quite possibly several. That means the cost of your meds is something to be aware of. Just because your medication is covered this year doesn’t mean it will be next. Is each of your medications covered in your plan’s formulary? What pricing tier is the medication in (and has that changed)? Are there restrictions, like being required to try a generic or less expensive drug before you can get access to the one your doctor recommends? And last but not least, is the pharmacy you prefer in-network for your plan? If not, you will pay more.
Lastly, if you have a Medicare Advantage plan, you need to make sure that your current care providers—doctors, specialists, and hospitals—will still be in network in 2022.
It’s important to be mindful of overall changes to Medicare, too. For instance, Original Medicare does not cover supplemental home health benefits such as transportation to and from doctor appointments, telehealth appointments, meal delivery, adult day care, and in-home personal support services. However, Medicare Advantage plans now may include those benefits. If they are important to you, you may want to consider switching to Medicare Advantage.
Also, if you use insulin, you should know that there has been an agreement with manufacturers of insulin drugs to cut costs for Medicare beneficiaries by up to 66%. Make sure that your Part D drug benefit is a participating Senior Savings Model plan, and that your particular brand of insulin is covered.
If it seems too hard to evaluate plans on your own, you can get help from knowledgeable professionals to decide what plan is right for you. You can contact your State Health Insurance Program (SHIP) or local Area Agency on Aging for assistance. There is also a Medicare Online Plan Finder. If you still have questions about Medicare open enrollment, please contact our law office as far in advance of the December 7 deadline as you are able.