5 Ways to Ace Medicare Open Enrollment
Key takeaways:
Medicare’s annual open enrollment period is October 15 to December 7.
Many seniors overpay for Medicare by sticking with the same plan year after year even if their medical needs change.
It’s important to read notices from your plan to learn about next year’s coverage.
Like pumpkin spice, open enrollment season is here again. And with Medicare plan options piling up like leaves, sorting through them to pick the best one for you can feel overwhelming. After all, choosing a plan that doesn’t fit can hurt you right in the wallet.
For less stress, use a process of elimination, suggests Sarah Murdoch, director of client services at the Medicare Rights Center. "If you see 30 plans available to you, eliminate all the ones that don't have your doctors in their network or your medications in their formularies," she says. Once you're down to a handful of plans, it's easier to compare them.
Below, we explore some expert tips to help you get the most out of Medicare open enrollment.
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1) Don’t pay for what you don’t need
"The biggest mistake people make is not reevaluating their healthcare coverage for the coming year," says Murdoch. And yet, in a 2019 government survey, more than 7 in 10 Medicare beneficiaries said they did not shop around for plans the previous year.
"People tend to assume that if their plan is working for them, it will be perfectly fine for the next year,” says Murdoch. “In reality, plans change from year to year.” Premiums can go up, doctors and specialists may depart from provider networks, and deductibles and copays can increase.
Most important for people with Part D coverage, especially if they take expensive medications: Drugs can be removed from formularies. Prescription drugs may move from a lower pricing tier to a higher one, raising your out-of-pocket cost for each refill. Giving your Part D plan a hard look each year can save you from surprise price hikes.
Over the years, Medicare "choice errors" can add up to hundreds, or even thousands, of lost dollars. Researchers cited by the National Council on Aging (NCOA) calculated how much Medicare Advantage enrollees paid in premiums and out-of-pocket costs. They then compared that total to each person’s estimated benefit. The greater the mismatch, the greater the “choice error.” They found that many people pay too much for the benefits they get, and that, even so, they rarely switch plans. Worse, notes the NCOA, ”the magnitude of these choice errors can actually increase over time."
2) Know the timeline and important deadlines
The annual open enrollment period — from October 15 to December 7 — is the one time that most people can make changes to their Medicare coverage. But you don’t need to wait for October to roll around before you start investigating plan options. "Get started early,” says Murdoch. “It's always better to have enough time to do the research you need."
During open enrollment, you can:
Join a new Medicare Advantage plan
Join a new Part D prescription drug plan
Switch from original Medicare (with or without Part D) to a Medicare Advantage plan
Switch from a Medicare Advantage plan to original Medicare (plus Part D)
Switch Part D plans
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You can make as many changes as you want. The plans you end up with will take effect January 1. If you're newly eligible for Medicare, keep in mind that your initial enrollment period (IEP) starts 3 months before the month you turn 65 and lasts 3 months afterward. It's best to start your health plan search well before your 65th birthday so you can enroll promptly and start the benefits as soon as possible. That will help you avoid a gap in coverage.
Also, if you’re buying Medicare supplement insurance (Medigap) for the first time, be sure to do it within your first 6 months of eligibility. During that period, you can buy Medigap without having to go through medical underwriting.
3) Gather all your relevant health information
Having key pieces of healthcare information on hand will help your Medicare shopping go smoothly. Gather these items:
An up-to-date list of prescription drugs you take, including dosage and frequency.
A current list of all your doctors and specialists.
Your preferred pharmacy, with address.
Total amounts you paid for premiums, deductibles, and copays last year.
Married couples should have this information available for each person. Prepare to shop individually, since there is no discount for having the same Medicare Part D plan as your spouse.
Bear in mind that any existing insurance coverage you may have, such as a group plan through your job, could affect your Medicare benefits. "If people have other health insurance or drug coverage, they should talk to their benefits administrator or other insurance provider before changing their coverage," says a spokesperson for the Centers for Medicare & Medicaid Services (CMS).
4) Review any changes to your current Medicare plan
If you have original Medicare, check the latest Medicare & You handbook for an overview of next year’s costs and benefits. Page 2 has a list of new and important facts. You can find more detailed information in other Medicare publications or at the Medicare website.
If you have a Medicare Advantage plan or a Part D plan, you should have already received an Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) by mail or email. It would have arrived by September 30. (If yours hasn’t come yet, contact the insurance company immediately.) The ANOC or EOC lists any changes in your plan’s costs, benefits, and rules for next year.
Such changes could include:
Premium amounts
Deductibles
Out-of-pocket maximums
Providers in your network
The cost of drugs in your plan’s formulary
New rules about prior authorization or step therapy
“With Medicare Advantage, provider networks can change, so make sure you have access to all the providers and medications you need for the coming year," says Murdoch.
Even if you like your current Medicare Advantage plan, it might not be your best option. The plan could be ending, or its rules might be changing. Or, maybe you can get everything you need from a cheaper plan. Reviewing the details will help clarify your choices. If you decide to make a change but miss the fall open enrollment period, don’t panic: You can switch during the special Medicare Advantage open enrollment period that runs from January 1 to March 31.
5) Shop for Medicare plans using online tools and free one-on-one assistance
There’s no need to make these decisions all by yourself. Plenty of Medicare-related tools and resources are available for consultation. Here are just a few:
Start shopping on the Medicare Plan Finder. Enter your ZIP code to find the available plans in your area. Include more information on your desired health and drug coverage to narrow down your options. Input all your prescriptions to see a detailed side-by-side comparison of plans and costs. If you use specialty medications or there are new generics available for you, switching plans might save you money.
Check provider networks, drug formularies, and preferred pharmacies for each person. "Married couples should choose based on their own doctors and prescriptions, not their spouse's or family members’," says Murdoch.
If you want assistance in either English or Spanish, you can call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. People who prefer live chat can do that 24/7. (Call centers are closed on major holidays, however.)
You can get personalized help with Medicare enrollment or changes by contacting SHIP. This organization has offices in every state, plus Puerto Rico, Guam, the District of Columbia, and the U.S. Virgin Islands. It’s overseen by the Association for Community Living. SHIP staffers and volunteers offer free, one-on-one help, with information specific to your state.
"You have trained counselors who help with these plan selections, who have many years worth of knowledge on how to do the research and the legwork," says Murdoch. SHIP counselors also tend to know the reputations of the health plans and provider networks. Contact your SHIP office early for an appointment and avoid the rush close to the deadline.
The bottom line
Medicare’s annual open enrollment period gives every beneficiary a chance to make changes to their coverage. Make the most of it. Look over last year’s expenses, review your current plan and any new changes to it, do some comparison shopping, and consult a counselor if you have questions. If you shop carefully during Medicare open enrollment, you'll thank yourself all year long for having the right coverage at the best price.
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References
Administration for Community Living. (2022). State health insurance assistance program (SHIP).
Fix, A., et al. (2021). Generic drug placement on part D generic tiers declines again in 2021. Avalere.
Gruber, J., et al. (2020). Managing intelligence: Skilled experts and AI in markets for complex products. National Bureau of Economic Research.
Kina, S. (2021). Choice error: How choosing a Medicare plan could impact your finances and health. National Council on Aging.
Koma, W., et al. (2021). Seven in ten Medicare beneficiaries did not compare plans during past open enrollment period. Kaiser Family Foundation.
Medicare Interactive. (n.d.). Changing part D plans.
Medicare Interactive. (n.d.). Medicare Interactive.
Medicare.gov. (n.d.). Contact Medicare.
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Medicare.gov. (n.d.). Live chat.
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Medicare.gov. (n.d.). Publications.
Medicare.gov. (n.d.). When can I sign up for Medicare?
Medicare.gov. (2021). Don’t wait: Medicare Advantage open enrollment ends March 31.
Medicare.gov. (2021). Medicare & you handbook 2022.
State Health Insurance Assistance Program. (n.d.). State health insurance assistance program.
