Medicare riddle: What do Annual Open Enrollment and Halloween have in common? Each year they seem to start earlier and earlier. Halloween candy appears on store shelves in September along with health plan solicitations in mailboxes, on TV and radio.
When individuals “age into” Medicare, the plan selection process can be a daunting and challenging experience. When I initially meet prospective clients in their homes, I often see piles of solicitations strewn across tables where they have unsuccessfully tried to compare the multiple options available in their county. The window of opportunity for selecting coverage begins three months prior to one’s 65th birth month, although we recommend that you investigate options up to six months prior to your birth month.
Each year, Annual Open Enrollment mirrors the “aging in” period, and over eight weeks offers consumers time to learn about plan design changes that have been approved by the Center for Medicare and Medicaid (CMS). The period runs October 15 through December 7; carriers can present their 2022 plans on October 1, but they cannot process applications until October 15.
Open Enrollment provides multiple opportunities to consider these options:
- Switch from an Advantage plan to another.
- Individuals with Medigap plans
- can consider another prescription drug plan (Part D) or
- terminate an Advantage plan and return to original Medicare (not recommended) and select a stand-alone Part D.
- If a beneficiary is happy with their existing coverage no decision is necessary as coverage will automatically roll over to their carrier’s 2022 plan design.
With each passing year, the competition for new members becomes more aggressive, prompting plans with enhanced benefits that can include home health care, hearing aids, eye wear, and transportation, just to name a few. When considering plan benefits, it is essential not to overlook plan provider networks and drug formulary, or a list of generic and brand name prescription drugs covered by your health plan. Participation in each can change each year and confirming the status of your doctors and drugs in the 2022 plan is important.
To aid in understanding changes, CMS requires each carrier to provide the Annual Notice of Change (ANOC) document. This alerts clients of their benefit changes from year to year, i.e., copay, deductibles, etc. The ANOC is an important document to review; in my experience, clients can often overlook this document in their regular mail delivery.
Other than allowable Special Enrollment Periods (SEP), there are few exceptions to change coverage during a calendar year. It’s important to be aware of the available options to avoid costly errors. For example, when confirming drugs in the formulary, you may find one carrier categorizes a drug as a Tier 2, when the same drug is categorized a Tier 3 by another carrier. A carrier can also change the Tier designation of a drug from one year to the next. The difference may cost the patient significantly over the next year if not noticed when confirming plans.
My goal in writing this article is to provide insight to those looking at Medicare, as decisions can be complicated and once made, can’t be changed for the calendar year unless you qualify for an SEP designation. Take time to consider options; a licensed health agent, certified annually to represent plans with Medicare contracts, can be a vital part of a risk adverse strategy. The role of an agent is to represent their client with no monetary incentive to favor one carrier over another, as their compensation is the same for each plan and regulated by CMS.
Since 2009, licensed health and life insurance agent (and Tucker resident) Bob Smith has represented major health insurance carriers for the ACA Marketplace, Medicare, Medicaid, Ancillary Plans and life insurance. For a free no-obligation quote and review of your health coverage programs call Bob at 404.593.9663 or email Bob@BobCareForYou.com. For additional insight, visit BobCaresForYou.com. From Obamacare to Bidencare to Bobcares℠ – Helping Families Protect Their Health, Wealth and Assets.Read More