Avoid some common confusions and missteps with Three Pillars’ Top 10 tip sheet. This streamlined guide touches on key differences in plans and cost saving measures to consider.
Our guide is for people who are already enrolled in Medicare. If you are new to Medicare or are becoming eligible soon (age 65), please visit medicare.gov for more information.
- Know your options during fall open enrollment
This open enrollment period allows you to assess and/or change your coverage for the upcoming year. Options include switching from Original Medicare to Medicare Advantage (given you have Medicare Part A and B, and live in the service area) or vice versa. You can switch drug plans, Medicare Advantage plans, or even enroll in Medicare Part D.
- Know what you can’t do during the fall open enrollment
Note that Medigap plans aren’t eligible for enrollment during this time. Enrollment for this type of plan should have been done during initial enrollment or during a special enrollment period.
You also may not enroll in Original Medicare for the first time during open enrollment. This may be done from January 1st – March 31st annually.
- Determine your coverage needs compared to what you have now
Look over your current coverages and note any cost or benefit changes. You can review all coverages and plans in your area in the 2022 “Medicare & You” handbook that you should have received, or view online here.
If you don’t have any concerns about your current plan and it’s still available for the next year, there is no action to take during open enrollment.
- Consider Original Medicare vs. an Advantage Medicare
Remember, you can’t join a Medicare Advantage Plan without having Original Medicare coverage (Part A and B).
Medicare Advantage is a bundled plan from an approved private company. They typically include Part A, B, and D. They sometimes have lower out-of-pocket costs than Original Medicare and include extra benefits like vision, hearing, and dental.
Original Medicare does allow you to visit any doctor or hospital in the U.S. that accepts Medicare, versus Advantage is limited to the plan’s network or doctors and hospitals. This follows with specialists; with Original you don’t need a referral, and Advantage you most likely do need a referral.
Original Medicare has no yearly limit on out-of-pocket expenses (unless you have Medigap), whereas Medicare Advantage (Part C) has a yearly limit based on that plan.
- Compare 2022 health plans online
Medicare.gov makes it easy to compare coverage and health plans online. Either log in with your existing account or create an account with your Medicare number. You’ll now have access to view your plan compared to others and see costs of drug prices applicable to your needs.
- Know your medications - are you taking any new drugs?
Drug prices fluctuate and plans don’t always include the drugs at the best price point. Ensure your plan covers your drugs and confirm the prices for those drugs aren’t more expensive than they would be on a different plan.
- Confirm your needs for specialists
If you are seeing a new specialist, double check that your plan covers that cost or fits within your budget. If you are on Medicare Advantage, make sure they are in network, and if you have Original Medicare, that the provider accepts Medicare. This will help avoid huge out of pocket expenses.
- Know what’s new this year
- End stage renal disease patients are now eligible to enroll in Medicare Advantage plans without conditions. This is helpful for people under age 65 and living in states that don’t guarantee access to Medigap plans for those under 65.
- Enhanced coverage is now in place for COVID-19-related items and services. This includes vaccines, tests, antibody tests, and treatments.
- Cognitive assessment and care plan services are now active. This was implemented to help detect the earliest signs of cognitive impairment. Follow-up services are also in the coverage plans.
- More details on all these new items can be found at medicare.gov.
- Need a personal expert to help?
Look no further than the State Health Insurance Assistance Program (SHIP). This incredible tool has tons of free information, events, and counselors ready to talk with you to answer your questions and concerns.
Visit shiphelp.org or call 1.800.242.1060.
- Just in case, know when the next open enrollment period is
You’re in luck, because if whatever you enroll for during this open enrollment period proves doesn’t work out, or if you make an error, you aren’t locked in until next year. There is another open enrollment period from January until the end of March.
Armed with these tips and an enrollment period that doesn’t end until December 7th, 2021 you can feel confident going into the fall open enrollment period.