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The 4 Golden Rules to Medicare’s Open Enrollment Period

By Lindsay Malzone September 28, 2020 Health and Fitness

With October right around the corner, it’s time to start preparing for Medicare’s Annual Election Period (AEP). Also known as Medicare Open Enrollment, it runs from October 15th to December 7th.

It’s important for beneficiaries to gather all necessary information about their plan, review their health history over the past year, and make an educated decision about whether to keep or change their current Medicare policy.

Regardless if this is your first or third AEP, this article will provide you with all you need to know heading into this period.

Are You Eligible to Change Your Plan?

First, you’ll want to determine if you’re eligible to make changes during the open enrollment period. If you’re newly eligible for Medicare, or delayed coverage for one reason or another, and are not yet signed up for Part A and Part B, this is NOT the enrollment period for you.

You won’t be eligible to make changes at this time unless you’re within your Initial Enrollment Period or are eligible for a Special Enrollment Period. You’ll need to wait until the General Enrollment Period to enroll in Original Medicare.

What Changes Can and Can’t Be Made During AEP

During the Medicare Annual Election Period, you can make multiple changes to your coverage, which is not the case for all enrollment periods. The changes you can make during AEP, which will go into effect on January 1st, 2021, include:

  • Switching from Medicare to a Medicare Advantage Plan.
  • Swapping one Medicare Advantage Plan for another.
  • Disenrolling from a Medicare Advantage Plan and enrolling in Original Medicare.
  • If switching back to Original Medicare, you’ll also have the option to enroll in a Medigap plan.
  • Signing up for a prescription plan through Part D.
  • If already enrolled in Part D, you can change from one plan to another.
  • Canceling your Part D coverage altogether.

How to Determine If a Policy Change Is Necessary

If you’re enrolled in Medicare Advantage and/or Part D, it’s important to keep in mind that benefits for these plans change each year. Bear in mind this can result in a premium increase and gaps in coverage.

If enrolled in any Medicare program, you should have received an Annual Notice of Change (ANoC) this month from your plan carrier. The purpose of the ANoC is to explain any changes to your current policy that will go into effect the following year.

In case you’re unhappy with the changes shown in your ANoC, you’ll want to weigh new options to see if there’s another plan that better suits your needs. If you’re satisfied with the changes, there’s nothing you need to do as your coverage will renew automatically.

Common reasons you may want to change your coverage include:

  • Significant increase in premiums/deductibles.
  • Doctors of choice are no longer in-network under your current Medicare Advantage plan.
  • The drug formulary no longer includes your medication.
  • You need a new plan that offers a better value or more comprehensive coverage.

What to Consider When Choosing a New Plan

If you decide that a new plan is what’s best for you, there are a few things to consider before moving forward with one.

Medication Coverage

One of the main reasons beneficiaries change plans during open enrollment has to do with medications. This includes medication/s being removed from the drug formulary as well as changes in the pricing tiers of medications.

There’s a chance the list will change every year, but given new rules that required some Medicare Advantage prescription drug plans to receive prior authorization for select pricey brand-name drugs, it can become even more difficult to get them covered by Medicare.

If you take expensive medications, it’s a good idea to explore other prescription plans available in your area to see if they have lower copays.

Medical Costs

Next, you’ll want to figure out what your predicted annual medical costs are going to be for the following year. Do this by putting together a list of expected doctor visits and procedures. Then estimate what that will cost out of pocket with your current Medicare plan versus the policy you’d like to switch to.

Add in what you’ll pay in premiums, and you will have an accurate estimate of your healthcare costs in 2021. If you’re unsure how to do this, it’s always a good idea to speak with an agent who can help you compare different plans.

Choose Benefits

Third, you’ll want to decide if you want your coverage to include vision, dental, and hearing benefits. As it stands, Medicare doesn’t cover routine dental, vision, and hearing services, but some Medicare Advantage plans do.

You can also buy dental, vision, and hearing coverage separately through Medigap, which tends to offer more comprehensive plans.

Travel Considerations

Lastly, you’ll want to consider if you’ll be traveling frequently in the year ahead. If so, you may want to delay enrolling in a plan until you are settled at your primary residence and ensure your plan has providers and pharmacies near where you live.

If you live in two places or plan to travel out of state, consider a plan with a nationwide network. You can also go with Original Medicare, which does not have provider networks.

Make an AEP Checklist

Now that we’ve covered the basics, it’s a good idea to bundle them into one checklist that hits on the three simple steps outlined above to make sure you’re properly prepared for open enrollment.

First, you’ll want to make sure you’re eligible to make coverage changes.

Next, you need to understand what changes can be made during this time.

Third, you’ll need to decide if you want to keep your current coverage or make a change.

And last, it’s always a good idea to contact an agent to help compare plans for the upcoming year. A professional can help you cut costs without sacrificing quality.

If you follow these four golden rules, this year’s open enrollment will be a breeze!

Do you rely on Medicare for your health insurance? What do you know about the annual open enrollment period? What don’t you know and need help with? Please share your questions and concerns, as well as any tips, in the comment box below.

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The Author

Lindsay Malzone is the Medicare expert for Medigap.com. She has been working in the Medicare space since 2017. Lindsay has a passion for sharing her expertise on Medicare to beneficiaries so they can be better prepared for healthcare costs after retirement. Her YouTube channel features various videos that help Medicare beneficiaries discover all their options.

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