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Beyond the Basics: Medicare’s Open Enrollment Period

Top questions—and answers—to help you make the best choices for Medicare coverage in 2022

Autumn is almost here, and the season also ushers in Medicare’s annual Open Enrollment Period. It may not be the most anticipated tradition of the season, but it can save you money and optimize your health care coverage for the coming year, so it’s worth taking e time to review your Medicare plans and spot any changes that may affect your coverage or costs.

Advantage spoke with licensed health insurance agents Vince Kelly and Rose Straub about some of the top questions Medicare beneficiaries have about the Open Enrollment Period and what to look for.

When is the Open Enrollment Period? Each year, Medicare’s Open Enrollment Period runs from Oct. 15 to Dec. 7. During this period, you can join, switch or drop a Medicare health plan or Medicare Advantage plan. You can change from Original Medicare (Parts A and B) to a Medicare Advantage plan (Part C), or switch from Medicare Advantage back to Original Medicare. You can also join, switch or drop Medicare drug coverage plans (Part D). Any changes you make take effect Jan. 1.

Is that the only time I can change my Medicare plan? There is a separate enrollment period just for Medicare Advantage, from Jan. 1 through March 31. You can switch between Advantage plans, or end your Advantage coverage and return to Original Medicare. However, you cannot switch from Original Medicare to a Medicare Advantage plan. Additionally, some life events trigger Special Enrollment Periods – for example, when you lose your current coverage or become eligible for Medi-Cal, move to a new coverage area, or move into or out of a skilled nursing facility, long-term care hospital or similar facility.

The amount of information can be daunting – is there any way I can quickly see what’s going to change? Each year the government mails an updated “Medicare and You” handbook to Medicare beneficiaries in late September or early October. “The inside front cover has a list of what’s new – it’s very useful,” Straub says. “Medicare and You” is also available online at www.medicare.gov/medicare-and-you.

The handbook has a lot of general information. How can I see what’s going to change just in my Medicare plans? In late September, Kelly says, you should receive a separate notice detailing how your plans will change in the upcoming year.

Is there any way I can easily compare plans and find what’s best for me? Yes! Create an account on the medicare.gov website and you’ll have access to Medicare Plan Finder, a tool that can help you find, compare and enroll in a new Medicare Advantage or drug plan in your area., Plan Finder can show you how different plans will affect coverage and costs for any prescription drugs you use, Kelly says.

What about the infamous Part D “donut hole” in drug coverage? “The donut hole is now called the coverage gap, but it’s the same thing,” Kelly explains.

“It has not gone away,” Straub agrees. “If you reach the coverage gap, instead of paying 100% for the cost for brand-name drugs, now you’ll pay 25%. The coverage gap affects about 10% of Medicare beneficiaries.”

What other costs should I look out for? “More and more people are falling into the high-income bracket,” Kelly says. “That means more people are paying more for the Part B premium. You should receive a letter from Social Security in November or December explaining what your deductible will be.”

How can I lower my Medicare costs? “The easiest way is to join a Medicare Advantage HMO program,” Kelly says. “You must use certain doctors, but you may be pleasantly surprised to see what doctors are available.” Locally, that includes primary care and specialty physicians in the Torrance Memorial IPA network (torrancememorialipa.org).

What trends in Medicare coverage and service should I be aware of? Kelly and Straub note that Medicare insurance has become very competitive. Many Medicare Advantage plans now offer extra perks such as transportation to medical appointments, discounts on dental care, basic vision care, or coverage for acupuncture and routine chiropractic treatment – all items not normally included in Original Medicare. However, to make up for the costs of those perks, plans may also have higher copays for other services.

Another trend is the increasing use of call centers as a way for insurance providers to enroll more customers. “These call centers typically use newer, inexperienced agents,” Kelly says, adding that agents calling from an out-of-area call center will not be familiar with the medical networks, physicians and other health care providers in your area. “Local agents are familiar with doctors and medical groups, and that’s important in making a good choice.”

“Know your agent!” Straub says. “Use local resources; people who know your local options… The most important consideration when choosing a plan are your doctors. The insurance plan is almost secondary. It’s the doctors that make people happy.”

Beware of insurance agencies who use celebrity spokespeople to endorse their products. While these hotlines may seem official, they are not, Kelly says. Callers hoping to get information from an official Medicare source instead are connected to a high-pressure insurance salesperson. Once you call, your information is in the company’s database, and during the Open Enrollment Period you may find yourself “continually harassed with phone calls from the many call centers located around the country,” Kelly says.

What’s the bottom line – how much time should I spend reviewing my Medicare coverage during the open enrollment period? “Plan changes typically are minor,” Kelly says. “In general, if you are happy with your plan, there’s no reason to change. It’s likely that you will be happy with your coverage next year.”

But, Straub says, a change can mean a significant increase in expenses for individuals using an expensive medication, if that change affects drug costs. She adds, deductibles are always increasing, especially for Part B coverage, and that’s certainly worth knowing.

So, bottom line? Whether it takes 15 minutes or a few hours, this fall get ready for the new year – it’s an early resolution you’ll be glad you kept.