Medicare open enrollment is about to kick off. For most people already enrolled in Medicare, the annual open enrollment period (Oct. 15 through Dec. 7) is the only opportunity to make changes to your existing Medicare coverage.
Even if you are happy with your Medicare coverage, you should take the time to explore your options. There may be a plan that is better suited to your health and financial needs that could save you hundreds of dollars in the upcoming year.
During 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; or switch from Medicare Advantage back to Original Medicare. All changes made to coverage during open enrollment take effect Jan. 1.
Dan Klein, president and CEO of the Patient Access Network (PAN) Foundation, an independent charitable organization dedicated to helping people afford out-of-pocket costs for prescribed medications, offers the following tips for navigating Medicare open enrollment.
Do your homework
Take the time to shop around and understand the benefits and costs of each plan so you can find the coverage that works best for you. Changes to your health status, doctors or other healthcare providers, prescription drugs or budget may mean that your current plan is no longer the most cost-effective choice. Insurance companies can also make annual changes to their plans that might affect the drugs covered, provider networks and out-of-pocket costs.
Make sure your doctors and providers are in-network
Before selecting a Medicare Advantage plan, check that your preferred doctors, hospitals and pharmacies are in the plan’s provider network. 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.
Note With Original Medicare you can go to any doctor that accepts Medicare patients.
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 the plan’s network of pharmacies makes it convenient for you to access your drugs. Switching prescription drug coverage, or even adding it for the first time, can help make the critical medical treatments you need less expensive.
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. Out-of-pocket costs 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 co-insurance. 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.
Determine how you will pay for your out-of-pocket costs
With rising deductibles, premiums, co-pays and co-insurance, the inability to pay 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. You should research your options now.
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 treatments.
By taking the time to re-evaluate your existing coverage and learn about all the options, you may be able to save significantly on your healthcare costs next year.
You can learn more about PAN and patient assistance charities by visiting PANFoundation.org. Other helpful online resources are available at: Medicare.gov, BenefitsCheckup.org and MedicareInteractive.org. (BPT)