Everything You Need to Know About Medicare Open Enrollment

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If you’re enrolled in Medicare then pay attention.

Every year Medicare has an open enrollment period. This year it’s from October 15 through December 7.

Open enrollment is your annual opportunity to switch your Part D prescription drug plan, or change your Advantage Plan provider, or move from Traditional Medicare to a Medicare Advantage Plan.

Bad choices during open enrollment result in higher premiums and more out-of-pocket expenses. If you miss a deadline, you could be without coverage, lose a tax break or even face a penalty.

Let’s break it down so you can save money and avoid problems.

Part D and Advantage Plan Changes

Did you know that Advantage Plan and Part D providers can change coverage rules every year?

Don’t assume your Part D or Advantage Plan will remain the same next year. In fact, there’s a pretty good chance something will be different.

A notice sent in late September shows any changes to plan coverage and cost. Make sure you read it.

By October 1, Medicare releases all the provider plans. This gives consumers two weeks before open enrollment to examine the plans.

Visit the Medicare Plan Finder website to see and compare plans as soon as possible. You should reevaluate your plan every year.

Prescription Drug Costs

If you take prescription drugs, look for changes in your prescription drug coverage. There may be a formula change, a tier change or a different co-pay amount.

Here’s an example: Last year your prescription drug was in a lower tier with a $5 co-pay. It’s possible that the same drug could move to a different tier that gives it a co-pay of $10 or even $20 dollars.

If you use a prescription drug on a regular basis, the extra co-pay cost could be significant. Look into buying your prescription online to save money.

If your prescription is available as a generic now, you might find a better deal.

Look for requirements like using a specific pharmacy to get the best rate. Some plans make you use a generic before a prescribed name-brand drug.

Take your current plan information and compare every detail with next year’s coverage.

It’s no fun to find higher costs after you enroll. You can’t change plans again until the next open enrollment period.

Medicare & Advantage Plan Coverage

Enter your zip code on the Medicare Plan Finder website, then type in the prescription drugs you take. Enter each drug and dosage into the online tool.

Answer a couple of questions and submit your prescription information. The tool states your premiums and plus out-of-pocket drug expenses for the plans in your area.

If you don’t take prescription drugs you can choose a plan without drug coverage.

You can choose several plans at a time and request a side-by-side comparison.

There is a tab for the previous year that lets you compare coverage between years.

eDrugSearch - save on medication costs and get free drug coupons

eDrugSearch - save on medication costs and get free drug coupons

Examine all your choices. You’ll see real differences between Traditional Medicare and Advantage Plans offered by private insurers.

The Advantage Plans often include vision, hearing and dental coverage. Each plan is different, so read all the details.

Plans are rated based on feedback from participants. A higher rating may influence your choice.

Spouses Can Choose Different Plans

A common misunderstanding is that married couples must buy the same plan.

It’s not true. There is no advantage or discount benefit to choosing the same plan.

Each person should make an individual decision based on health. If one person takes a lot of medication, and the other one doesn’t they want different plans.

If you choose different plans, pay attention to rules regarding pharmacies and drug choices. Convenience may matter more than the cost in some situations.

Out-of-Network Penalties

If you choose an Advantage Plan, look at which doctors and hospitals you can use to get the lowest copay.

Some plans won’t cover any out-of-network providers, except for emergencies.

It’s a good idea to check with your current doctors and hospitals to see if they are in your plan each year. If it changes, you can switch your Advantage Plan during open enrollment.

Swap Your Medicare Advantage Plan

There are three times outside of open enrollment when you can switch your Medicare Advantage Plan.

  1. New Location
    If you move outside of your plan’s service area, you can change.
  2. 5-Star Plan
    If a 5-star plan becomes available in your area, you can switch to it.
  3. Advantage Plan to Traditional Medicare
    You can change an Advantage Plan to a Traditional Medicare with Part D prescriptions.

Don’t hesitate to switch if one of these circumstances occurs during the year.

Get Help with Medicare Questions

If you are enrolling for the first time, or tenth, and have more questions, contact your State Health Insurance Program (SHIP) for help.

You can find local help and advice for free. SHIP provides objective advice to help people understand their Medicare options.

Help is available online, in person or on the phone. Anyone can get information including beneficiaries, their families, friends, and caregivers.

Help is available in every state, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. The service is through the U.S. Department of Health and Humans Services.

Lower Your Healthcare Costs

Don’t forget to spend time shopping for the best deals for your prescription drugs. You can factor it into your plan choice.

Please use this information to make smart choices when you enroll in Medicare this year.

Attention to details can reduce your healthcare premiums and out-of-pocket expenses.

About Cary Byrd

eDrugSearch founder, Cary Byrd, has been called an “e-health innovator” by MarketIntellNow, interviewed by top pharmaceutical industry journalists, invited to Matthew Holt’s Health 2.0 Conference and a Consumer Report's health summit, and highlighted on numerous health blogs.

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