Every year, Medicare gives beneficiaries eight weeks in which to make changes to their healthcare coverage. Beginning October 15 and lasting through December 7, the Medicare Annual Enrollment Period (AEP) is your chance to make changes to your Medicare coverage.
During this time, you can change from Original Medicare to a Medicare Advantage (MA) plan. You can also change to a different MA plan, move back to Original Medicare, and choose a new Part D prescription drug plan.
Even if you’re happy with your current coverage, it is vital that you take advantage of the AEP. Changes from year to year may result in you paying more, particularly if your provider leaves your network or your drug plan no longer covers your prescriptions. In this post, we walk you through the Annual Enrollment Period to help you get the best coverage at the best price.
Deciphering the Medicare Alphabet
Like most government programs, Medicare tends to be confusing at first glance. Part of that confusion comes from the fact that most articles about the program assume you already know what all the terms mean. That’s why we’re including this basic breakdown of common Medicare terms.
- Medicare Part A: The first half of Original Medicare, Part A pays for covered inpatient hospital services.
- Medicare Part B: Commonly known as medical insurance, Part B is the second half of Original Medicare. It pays for covered services such as doctor appointments, outpatient treatments, and lab work.
- Original Medicare: This includes Parts A and B.
- Medicare Part C: If you had group coverage through an employer, that gives you an idea of Part C. More commonly known as Medicare Advantage, these plans are provided by private insurance companies. Most people choose an HMO or PPO plan, although other options are available. Part C plans must offer the same coverage as Part B, but most offer additional services, such as prescription drug coverage. Details and costs vary by plan.
- Medicare Part D: The Medicare program now requires beneficiaries to have prescription drug coverage. If you do not have creditable coverage (i.e. equal to or greater than what you’d get through a Medicare plan), then you need either a Part D plan or an MA plan that covers prescriptions. Like Part C, private insurers back these plans, and costs vary according to the plan and insurer.
- Drug formulary: Covered prescription drugs are listed on the drug formulary, which typically groups prescriptions in tiers (example below courtesy of Medicare Solutions).
What Changes Can You Make During Medicare Annual Enrollment?
During Annual Enrollment, you can:
- Change from Original Medicare to an MA plan
- Switch to a different MA plan
- Move back to Original Medicare from an MA plan
- Enroll in a Part D plan
- Switch to a different Part D plan
What Are Your Current Healthcare Needs?
Start the AEP process by reviewing your current healthcare needs. After all, you can’t know whether a plan meets your needs without a starting point. Create a list of:
- Your current providers, including doctors, labs, pharmacies, hospitals, i.e. any person or place you rely on for healthcare
- All of the prescriptions you currently take
- Any chronic conditions you have
- Changes you expect to occur over the next 12 months
- Any procedures you have scheduled
- What you currently pay out-of-pocket, including premiums, copays, coinsurance, and deductibles
If you have a disaster plan, you may already have this list. If not, add this list to your plan. Having a current list of your prescriptions is especially important.
Review Your Current Coverage Documents
All Medicare providers are required to send plan beneficiaries two documents every year. The Annual Notice of Change (ANOC) details any changes your plan expect to occur the following year. You should receive this by the end of September. At the same time, you should receive the Evidence of Coverage (EOC), which includes costs and other plan details.
Because they receive so much Medicare-related mail during the fall, many beneficiaries ignore these documents. This is a mistake. Medical insurance plans change every year. The ANOC and EOC detail those changes, including:
- Costs: Your out-of-pocket costs nearly always change from year to year. Monthly premiums, yearly deductibles, copays, and more may increase or decrease.
- Covered services: Many Medicare Advantage plans cover additional services. These may change from year to year.
- Provider network: Physicians, clinics, and other providers enter and leave networks. If your doctor leaves your network but you ignored the ANOC, you won’t find out until your claim is denied. Not reading the notice does not protect you from having to pay.
- Drug formulary: Prescription drug plans regularly update their formularies. Even if your prescription remains on the formulary, it may wind up on a new tier, impacting your out-of-pocket costs.
Use the ANOC, EOC, and your list of current healthcare providers to compare your plan options.
Compare Medicare Plans
Even if you’re happy with your current coverage, it’s important to remember that all Medicare plans change from year to year. What’s more, Medicare Advantage plans keep growing in popularity, which means there are even more plans to choose from.
All of that choice can get pretty confusing. You have two tools available to help you, if it feels overwhelming. The Medicare Plan Finder lists all of the plans in your area, which is a big help in narrowing down your options.
The second tool is a Medicare insurance broker. As with other insurance brokers, they work with numerous insurance companies. Just tell the broker about your healthcare needs and they help you find the best plan at the best price. Type “Medicare broker” and your location into your search engine to get started.
Beware Common Medicare Scams
Where Medicare is concerned, there seems to be no end of scams. As long as you remember a few things about Medicare, you should be okay.
- Medicare will never call you. This is the most important thing to remember. Unless you’re already working with someone from Medicare about an appeal or similar issue, or you specifically requested a call, no one from Medicare will ever call you. All communications are via the United States Postal Service. To receive communications from Medicare, you need to make sure your mailing address is correct with Social Security.
- Medicare will never call to ask for personal or private information. Nobody from Medicare will ask you for your bank account information, credit card number, or social security number. If you call them, they may ask you to verify your information, but that’s it.
- You don’t have to pay for the new Medicare card. Medicare began sending out new, more secure membership cards in April of 2018. By that time, scam artists had already begun their tricks, calling beneficiaries (see item 1) and claiming they needed to pay for the card or verify their address (see item 2).
If anyone tries to scam you or calls pretending to be from Medicare, you don’t have to do anything. But, you can help stop these kinds of scams by reporting the incident to 1-800-MEDICARE.
