Even if you already have Medicare, don’t dare to skip the open registration
The open registration for Medicare is here! This is your chance to review your coverage and see if you can save some money next year. This is the time when you can make the changes to your health care coverage that best suit your needs. While it’s common for older people to assume that they can keep the same coverage every year, this can be a costly mistake.
Each year, from October 15 to December 7, registrants can:
Switch to an Advantage plan from original health insurance (Part A hospital coverage and Part B outpatient coverage);
Switch to original health insurance from an Advantage plan;
Switch from one Advantage plan to another;
Switch from one drug plan (Part D) to another, or buy one if you didn’t do so when you first qualified (although you could face a penalty if you do. late registration).
According to the Centers for Medicare and Medicaid Services, 63.3 million people were enrolled in Medicare as of July 2021.
So you might be thinking that if you’re already enrolled in Medicare, why bother with open enrollment?
According to a Kaiser Family Foundation survey, 57% of Medicare beneficiaries don’t review or compare their coverage options every year. Failure to do so could prove costly, especially if you are living on a fixed income in retirement. The changes may affect your premiums, deductibles, co-payments, and covered services, as well as participating physicians, hospitals, pharmacies, and other providers.
Here are four things I encourage my clients to review each open Medicare enrollment season:
1. Changes to your health insurance plan
If you have a Medicare plan, you will receive an Annual Change Notice (ANOC) notifying you of any changes in coverage, costs or area of ââservice. Note any changes made in 2022 to your health coverage or any additional help you may get to pay for prescription drugs.
Of course, premiums aren’t the only factor to consider. Generally, plans with lower premiums may have higher deductibles and co-payments. Plans with higher premiums tend to have lower deductibles and co-payments. As you determine which coverage is best for you, calculate the worst-case scenario so you can pay the maximum out of pocket expenses for the plan you choose.
When you compare your current plan to potential new plans, here are some things to consider:
Costs: Look at both the premiums and the out-of-pocket expenses.
Blanket: Medicare and original Medicare Advantage both offer full benefits, but you can find a Medicare Advantage plan with additional benefits.
Prescription drugs: Find out which prescription drugs are covered by each plan and the costs.
Choice of doctor and hospital: Not all doctors and institutions accept all health insurance plans. Make sure your suppliers, hospitals, and facilities agree to the plan before choosing it.
Quality of care: Medicare ranks each Medicare Advantage plan based on the quality of care. If you compare Medicare Advantage plans, you want to see their star rating.
Plan design: Medicare Advantage insurers offer several plans, such as Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) plans. PPOs have fewer restrictions but cost more than HMOs, which typically have smaller networks and don’t pay for off-grid care.
2. Changes in your health
It might not be possible to predict your health needs or how you would use your coverage. But take the time to think about how often you might need health services in the coming year.
If you are going to start seeing a specialist, how much could it cost you per visit? Perhaps you have surgery on the horizon that could cause your deductible to run out quickly.
Health insurance plans, in general, do not cover dental, hearing or vision needs well. Do you plan to need a new hearing aid? Are your eyeglass or contact lens prescriptions up to date? Will you need a crown on your teeth or even an extracted tooth? Take the time to understand what your Medicare Advantage will cover and what you may have to pay.
Remember that Medicare is individual health coverage. Select the plan that will best cover you and your health needs.
3. Changes to your Medicare MAPD or Part D plan
Most Medicare drug plans (Medicare Part D and Medicare Advantage plans with prescription drug coverage) have their own list of covered drugs, called a formulary. The plans will include brand name prescription drugs and generic drug coverage. All Medicare drug plans must cover at least two drugs per drug class, but plans can choose which Part D drugs they will offer. The formulary may not include your specific medication. In most cases, a similar drug should be available.
Medicare Prescription Drug Levels:
Level 1 : Covers most generic prescription drugs. You will pay the lowest co-payment.
Level 2: Covers preferred branded prescription drugs. You will pay an average co-payment.
Level 3: Covers non-preferred branded prescription drugs. The co-payment will be higher for these drugs.
Specialty Levels: These drugs have very high costs. You will pay the highest co-payment, and you may also need to pay coinsurance.
Depending on the plan’s prescription drug formulary and the coverage restrictions in place, the amount you pay for certain drugs may be higher in 2022. View your current prescriptions on the new formulary. New stand-alone drug plans might also be available where you live, which is worth comparing prices.
4. Changes in your prescription drug needs
In addition to reviewing changes to your drug plan, you should also review changes to your individual medications. Will your doctor potentially change a prescription for you this year? Do you plan to add new prescriptions? Consult with your doctor and pharmacy to understand what medications you may need and the potential costs of those medications.
Health care continues to be one of the biggest expenses in retirement. As health care costs rise, they can consume more of your retirement budget – and you need to be prepared.
Take the time to consult with a medicare professional this open medicare enrollment season to ensure you have the best coverage for you in 2022.
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