For most people enrolled in Medicare, the annual open enrollment period from Oct. 15 through Dec. 7 is the only time you can make changes to your existing Medicare coverage. Whether you’re satisfied or dissatisfied with your coverage, this is the time to explore your options as there may be a plan better suited to your health care needs that could save you money in the upcoming year.
During Medicare open enrollment, Medicare beneficiaries can:
- Switch Part D prescription drug plans
- Switch Medicare Advantage plans, which offer health (and often drug) coverage through private insurers
- Switch from Original Medicare, administered by the federal government, to Medicare Advantage
- Switch from Medicare Advantage back to Original Medicare
As you begin to research your options, consider these tips for navigating Medicare open enrollment from Dan Klein, president and CEO of the Patient Access Network (PAN) Foundation, an independent charitable organization dedicated to helping people afford out-of-pocket health care costs. Keep in mind, all changes made to coverage during open enrollment take effect on Jan. 1, 2021.
1. Do your homework and research changes
Changes to your health status, prescription drugs, budget, or doctors or other health care providers may mean that your current plan is no longer the most cost-effective choice for you. Insurance companies can also make annual changes in your Part D prescription drug plan or Medicare Advantage plan that might affect the drugs covered, provider networks and your out-of-pocket costs. Visit Medicare.gov to understand the benefits and costs of each plan so you can find the coverage that works best for your current needs. Furthermore, consider going over your plan with an expert; the State Health Insurance Assistance Program offers free (government-funded) one-on-one consultations.
2. Check that your doctors and providers are in-network
It’s smart to check that your preferred doctors, hospitals and pharmacies are in the plan’s provider network, especially before selecting a Medicare Advantage plan. If you visit a doctor, hospital or pharmacy that is outside of the network, you will likely have to pay more. If your insurance company has changed your plan’s provider network for next year, you may want to use open enrollment to switch to a plan that will include your current doctors, hospitals and pharmacies in-network to lower your medical costs. Additionally, check telehealth coverage so you can meet your doctors over the phone or on the computer if appropriate. Note: With Original Medicare, you can go to any doctor, health care provider, hospital or facility that accepts Medicare patients.
3. Make sure your medications are covered
Medicare Part D helps cover the cost of prescription drugs. Many Medicare Advantage plans provide prescription drug coverage as well. It’s important to ensure that your plan covers the medications you need and that it’s convenient for you to access your drugs through the plan’s network of pharmacies. Switching prescription drug coverage, or even adding it for the first time, can help make the critical medical treatments you need less expensive.
4. Assess if your plan is still a good fit for your budget
Annually, there may be changes to your Medicare plan that affect your out-of-pocket costs. These are your expenses for medical care that aren’t reimbursed by insurance. When selecting a plan, you should consider what you will be responsible for paying under the plan, including the deductible, out-of-pocket limit, co-pays, and coinsurance. Also, if you are enrolled in Original Medicare and do not already have supplemental coverage, now may be a good time to consider purchasing a Medigap plan.
5. Determine how to pay out-of-pocket costs
With rising deductibles, premiums, co-pays and coinsurance, the inability to pay for out-of-pocket costs is a growing problem for people with Medicare. There may be assistance available to you if you cannot afford the out-of-pocket costs for your prescription medications.
If you have limited income and resources, you may qualify for a federal Medicare Low Income Subsidy (LIS) — also known as Extra Help — to help pay for your prescription drug costs. You may also be eligible for a patient assistance program that provides people with financial assistance to cover out-of-pocket costs for their medical treatments. You can learn more about PAN and patient assistance charities by visiting PANFoundation.org. Other helpful online resources are available at:
Don’t delay; act now. By using the open enrollment period to evaluate your existing coverage and learn about all your options, you may be able to save significantly on your health care costs next year.