Revenue Cycle
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6 Reasons to Review Your Medicare Coverage During Open Enrollment

by | Nov 11, 2021 | American Exchange News, Enrollment, Healthcare, Medicaid, Medicare, Open Enrollment

Medicare’s open enrollment period runs from October 15 – December 7. There are a lot of things you can do now that you can’t do any other time of the year. 

You can:

  • Move from Original Medicare to a Medicare Advantage Plan.
  • Move from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another. 
  • Switch from a Medicare Advantage Plan that doesn’t offer prescription drug coverage to a plan that offers it.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a plan that doesn’t offer it.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare Prescription Drug Plan to another.
  • Drop your Medicare prescription drug coverage.

Do I have to do anything to stay enrolled in Original Medicare?

No. If you do nothing, you will keep your Original Medicare (Parts A & B) coverage in 2022. 

Do I have to do anything to keep my Medicare Advantage plan?

No, as long as your plan is still offered. If it isn’t, you will have to pick another plan.  

If you’re enrolled in a health plan, you should have gotten an Annual Notice of Changes. This letter tells you how your plan coverage, costs, and service area will change in 2022. If you are okay with the changes, you don’t have to do anything to stay enrolled.

Medicare changes each year. So do you.

Here are 6 reasons why you should review your Medicare options each year:  

  1. Your health changed

You may be going to the doctor more or less often, take different prescription drugs, or need better access to health care services or specialists. You could find another plan that better meets your needs or lowers your costs. 

You may also qualify for a Special Needs Plan (SNP), which is a Medicare Advantage for people:

  • With specific diseases like cancer, chronic heart failure, or stroke
  • Who are in a facility, like a nursing home, or who need nursing care at home
  • Who are eligible for both Medicare and Medicaid.  

Learn more about special needs plans, including what diseases are included.

  1. Your income or asset level changed

There are programs that help pay premium, deductible, prescription drug, and other out-of- pocket costs for low-income people on Medicare. Income and asset limits apply.  

Medicaid: a joint federal/state program that helps with medical costs 

Medicare Savings Programs: help paying premiums, deductibles, coinsurance, copayments, and prescription drug coverage costs

Program of All-inclusive Care for the Elderly (PACE): a Medicare/Medicaid program that helps people meet health care needs in the community.

Extra Help (Part D): lowers Medicare prescription drug (Part D) costs

Programs for people in U.S. territories: programs for people with limited income and resources living in Puerto Rico, U.S. Virgin Islands, Guam, Northern Mariana Islands, and American Samoa

  1. New plans may be offered in your area 

A new plan may cost less or cover more services, like dental or vision care, than the plan you have now. 

  1. Your Medicare Advantage or Medigap plan monthly premium increased 
  • If your monthly health plan premium is going up, you should look for a similar plan at a lower price.   
  • If you have Original Medicare with a Medigap policy, the monthly Medigap premium may be going up. A Medicare Advantage plan may cost less. 
  1. Your doctor may no longer be in the network 

Networks change each year. You need to be sure that all the healthcare providers you see are in your plan’s 2022 network. If not, you will either need to change doctors or pick a plan that includes your providers in its network. 

  1. Your medicine is no longer on the plan’s formulary 

A formulary is a list of generic and brand name prescription drugs covered by your health plan. Formularies change each year. 

Check what tier your drugs fall into. Each health plan splits drugs into groups, called tiers. The tier a drug is in depends on its type–generic, preferred brand, non-preferred brand, and specialty. The lower the tier, the lower the cost of the drug.

Not all plans have the same number of tiers, and they don’t all put drugs into the same tiers. Plan ABC may list a medicine in tier 1, but Plan XYZ lists the same drug in tier 2, where it costs more. 

Make sure your drugs are on the plan’s formulary and know the tiers they fall in. 

Now’s the time to review your options

You have until December 7, 2021 to review your current Medicare coverage. You can compare cost, services, and drugs across plans offered in your area. You can also compare quality and performance by looking at each plan’s star rating. 

Pay attention to all the costs of your options. A plan with a lower monthly premium could end up costing you more if you visit the doctor often or take a lot of medicines. Add up your total out-of-pocket costs in 2021 to get an idea of the same costs in 2022. Include premiums, deductibles, co-pays, and drug costs. If you have Original Medicare, add in the cost of your Medigap plan. 

American Exchange can help you find the best plan for your needs

If you don’t want to sort through all the plans in your area or just want expert help, American Exchange is here for you. Our licensed insurance benefits managers can help you compare plans, prices, networks, formularies, and tiers. We can also let you know if you qualify for cost-saving programs. We do not work for an insurance company, so we compare all plans in your area  at no cost or obligation to you. Contact us today. 

American Exchange is a licensed health insurance broker. Robert Huffaker, NPN 13568432