Every year millions of Medicare beneficiaries are confused about what they should do during the fall annual election period (AEP). You will see the onslaught of television ads and mail in your mailbox, but I know it’s confusing whether the election period applies to you or if you need to take any action.
The AEP was created alongside the new Medicare Part D program, which was rolled out in 2006. Because plans can change their premiums, benefits, copays, networks and drug formularies from one year to the next, Medicare needed to also allow beneficiaries to change their coverage if they don’t like the changes or if they just want to comparison shop for a better-suited plan from year to year.
So, the AEP runs from October 15 to December 7 each year. It is a time when beneficiaries can enroll in, change, or disenroll from their current Medicare Part D drug plan or Medicare Advantage plan if they have one.
Here are some important things to note if you are currently receiving Medicare (or about to):
If not, please share this with someone you know who is – a parent, grandparent, coworker, friend…
The election period does not affect Medigap plans
If you have a standalone Part D drug plan, chances are that you also have a Medicare Supplement (Medigap plan). The benefits on Medigap plans do not change from year to year, so the AEP has nothing to do with Medigap plans.
Many of you are confused about this and believe that you can use the AEP to change from one Medigap plan to another without having to answer health questions. Unfortunately, this is not the case. Though you can apply for a new Medigap plan at any time of year, this change requires you to answer health questions and go through underwriting in most states.
The underwriter for the new Medigap carrier can accept you or decline you based on your answers and the information found in your medical record. Certain prescriptions can also cause an automatic rejection.
I tell people not to worry about their Medigap plan until their next policy anniversary. When that time rolls around, if a rate increase occurs, then that’s a good time to tackle applying elsewhere for a lower rate.
Your annual notice of change letter is important
Every year in September, your current insurance carrier will mail you an annual notice of change (ANOC). This letter details everything that is changing in the plan next year. The letter will list the plan’s benefits for each year side by side so that you can easily spot any changes that will affect you.
Some of the most important things to look out for are changes in the monthly premium and changes in the drug formulary. You may like your current plan just fine, but if the plan is dropping coverage next year for an important brand-name medication that is taken regularly, shopping that coverage to find a plan that covers that same medication next year is important and with the cost of some medications, may be critical.
Medicare has tools to help you evaluate your options
There are several online resources to help you with your plan decision making. The most important of these is the Medicare Plan Finder tool. You can use this tool to evaluate all your Medicare Part D or Medicare Advantage plan options in your county for next year.
To shop for the plan with the most cost-effective rates for next year, you first need to have a ready list of your currently prescribed medications. You can use the tool and enter your list of medications and each medication’s dosage and frequency. The tool will crunch the numbers and pull up a list of drug plans offered.
The tool is being revised for next year and will no longer retain saved data about prescription drugs. If you wish to save your list of medications, you should first sign up for a MyMedicare.gov account and then enter your drug lists there. This account will also benefit you in managing claims and accessing your personal health information throughout the year.
What to consider when changing Medicare Advantage plans
Some of you choose to get your coverage through a Medicare Advantage plan. These are private insurance policies that pay instead of Medicare and they have networks of providers. If you wish to change to a different Medicare Advantage plan, you need to verify that your favorite providers are in the network for the next plan. Each plan has an online directory where you can search to determine this information.
Some of you may wish to leave your current plan and just return to original Medicare instead of to another Medicare Advantage plan. This can easily be done by notifying the current carrier in writing that you wish to disenroll or calling 1-800-MEDICARE to make the change by phone.
Remember if you wish to add a Medigap plan to your original Medicare, health questions may apply. It’s a good idea to apply for the Medigap plan first to ensure you can get approved before disenrolling from your Medicare Advantage plan.
Totally Confused?
Call me and we’ll refer you to someone who can help.
