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Why Medicare Open Enrollment is Important

Cristina Ramey, Lenbrook Director, L.I.V.E.!
October 6, 2016

Medicare Open Enrollment starts Oct. 15 and goes through Dec. 7. This is the time for all Medicare enrollees to compare their current plans and decide if they are in a position to make any changes that could have great potential to save them money.

Having a choice is a good thing. However, too many choices can be overwhelming.  It is important to first understand what you actually have. Medicare has several parts to it, so let’s review.

“Original Medicare” Part A & Part B

  • Standard Part A and Part B insurance that you are entitled to once you reach 65
    • Part A – covers hospital stays, care in skilled nursing, hospice care and some home health care
      • No monthly premium
      • Co-payment, deductibles and coinsurance fees apply
    • Part B – doctor visits, outpatient care (rehab), preventative care & medical supplies
      • Monthly premium – which can vary based on your income level
      • Covers 80% of your medical costs

Supplemental Insurance

  • Private insurance you can purchase to help pay for costs Medicare doesn’t pick up (the remaining 20%), such as:
    • Co-payments
    • Deductibles
    • Co-insurance (when you pay a % of medical services)
  • The monthly premium can vary based on your eligibility period, current age and/or medical history
  • All supplemental plans are standardized, so the plan you pick through one insurance agency will have the same coverage as the same plan you might pick through another insurance agency. The difference in cost lies solely in the premium cost. Use a Certified Medicare Consultant to shop around. Many are free

Medicare Advantage (MA) Plans

  • With a MA plan, you opt out of Original Medicare and have a private insurance company “manage” your care.  This option is often appealing due to very low premiums and additional benefits such as dental or vision coverage. It often includes Part D for your prescriptions.
  • There are limitations with a MA plan:
    • Limited network of providers
      • If you use a provider outside of your MA plan’s network, you could be responsible for out of pocket expenses.
    • Doctors can drop out midyear
      • This could leave you at risk of looking for a new doctor
    • Individuals are responsible for all cost-sharing
      • Share of costs covered by your insurance that you pay out of your own pocket
    • Frequent travelers to other states
      • Make sure your MA will be accepted in another state should you have an unfortunate event while traveling

Part D is Prescription Drug Coverage

  • Ensure the medications you currently take will be covered by your plan next year since insurance agencies have the right to make changes to their formularies every year.
  • If you’ve had the same Part D plan for multiple years, it’s almost guaranteed that your monthly premium has increased. Sometimes just switching to a new Part D plan can significantly reduce your monthly premium

What You Can Do Now 

I always encourage people to review their options, even if they choose not to make any changes.

But at the very least, please review your Medicare Part D . You can do it yourself on the internet by going to www.medicare.gov. Use the website’s Plan Finder to do a Personalized Search.  Here you will enter YOUR personal drugs, dosage and frequency amounts and your preferred pharmacy.  This will allow you to select the best and most cost effective plan for the coming year.

If you are in a Medicare Advantage plan and you wish to see if you can change back to Original Medicare and purchase a Supplemental plan, you will want to work with a Certified Medicare Consultant.  One agency that is highly reputable is Affordable Medicare Solutions. Their consultations are always free. You can call them at 770-945-5261 or visit them at www.affordablemedicaresolutions.com.

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