We are quickly approaching Medicare Open Enrollment, which will span October 15 to December 7. Medicare consumers should be educated about the market. Here are three common misconceptions:
1. Medicare works like health insurance for people under 65: Not true. Americans under 65 most often have plans with private insurers that cover services within a network of providers. Medicare beneficiaries, however, usually get primary coverage with Original Medicare through the government. Private insurers provide secondary coverage through supplemental plans. Alternatively, consumers can enroll in Medicare Advantage plans to replace Original Medicare. These plans can differ widely in price, so it pays to use a broker to shop around. 2. A Medicare supplement plan from a different insurer can offer better benefits: Not true. Medicare supplement plans, by law, offer standardized benefits. "Plan G" from Insurer A or from Insurer B offers the same benefits. What differs? Three things: price, customer service (processing of claims), and advertising. For the consumer, of these three, price is by far the most important while advertising is the least important. Major insurers tend to be reliable in processing of claims because of government oversight. 3. Medicare Advantage Plans and Prescription Drug Plans are similar across insurers: Not true. Medicare Advantage Plans are similar to health insurance for people under 65 in that they limit access to networks. Therefore, it is important to understand network coverage before enrolling in a Medicare Advantage Plan. Likewise, prescription drug plans differ in their drugs covered since each has its own formulary. An individual should select a plan based on the medications needed. Each Medicare Advantage and Prescription Drug Plan has its unique cost arrangement. Pay attention to the deductibles, copayments, and coinsurances of a plan before enrolling. As well as understanding product features, Medicare beneficiaries should be aware of important deadlines. Several timing rules often apply:
1. Initial enrollment period for Part B: Most people become eligible for Medicare when they are 65 or older and eligible for Social Security. Medicare beneficiaries need to sign up for Medicare Part B when first eligible or pay an enrollment penalty. The initial enrollment period for Part B begins three months before a senior is eligible for Medicare and ends three months afterwards. This period lasts a total of seven months since it includes the month of eligibility. Part B covers outpatient surgery and doctor visits, so it is a crucial part of a senior's medical coverage. 2. Initial enrollment period for Medigap plans: In most states, a Medicare beneficiary shopping for a Medicare supplement plan has a guaranteed issue period that lasts for six months after turning age 65. An insurer must issue a Medicare supplement to any senior who applies during this open enrollment period regardless of health conditions. Insurers have the right to deny coverage or charge higher rates to seniors who apply after their initial enrollment period. This rule is especially important for seniors with preexisting conditions that require extensive medical care, such as cancer or surgical needs. 3. Special enrollment period for loss of employer coverage: Medicare beneficiaries who lose employer health insurance have a special enrollment period that lasts for two full months after coverage ends. During this window, a senior has the right to purchase a Medicare Advantage or Prescription Drug Plan. Loss of employer coverage for a senior older than 65 also confers guarantee issue rights to a senior applying for a Medicare supplement policy for 63 calendar days. Missing these dates could result in a gap in coverage, so be mindful of these rules. It is vital to pay attention to timing when taking care of a senior's Medicare needs. If you feel overwhelmed, reach out to a broker for help. Now that 2022 Open Enrollment has ended, it is useful to look at insights from surveys.
Here are some key findings from a survey conducted from Ehealth: 1. Most Medicare Advantage enrollees cannot afford the alternatives. 2. Many Medicare beneficiaries have chosen not to make reconsider coverage alternatives in several or more years. This means that they are likely not in the optimal plan for themselves. If someone you know needs help with Medicare, you can reach out to us at Well Spot. The Medicare Advantage Open Enrollment Period this year is from January 1, 2023 to March 31, 2023. If you are enrolled in a Medicare Advantage Plan, you have the option to:
1. Return to Original Medicare 2. Switch to a different Medicare Advantage Plan Be aware that you can only make an election once during this period, which ends March 31. We are now in the Medicare open enrollment period for the 2023 Plan Year.
A couple keys for this year: 1. The open enrollment period will be between October 15-December 7, as in prior years. This is the period in which you can switch Medicare Advantage Plans starting with a January 1, 2021 effective date. You can also elect to switch from Original Medicare to coverage under a Medicare Advantage plan. 2. Pay attention to changes in plans available. Insurers change plan premiums and benefits each year, so be on the lookout for any changes. Medicare Part B premiums are expected to increase, although the increase might be capped this year due to legislation. Consider your budget and needs when choosing among plans. Just what is Medicare? That seems like really easy question, but it's not so easy to grasp at first.
There are actually three distinct types of Medicare: 1. Original Medicare 2. Medicare Advantage 3. Medicare Supplement Original Medicare is offered by the government, and most people become eligible when they turn 65. If you are enrolled in Social Security, you are automatically enrolled. But if you are not, you need to enroll online or at your local Social Security office. Medicare Advantage and Supplemental plans are additional ways to get retiree health benefits offered by insurance companies. They are offered by brokers such as ourselves. In short, do yourself a favor and familiarize yourself with the various flavors of Medicare. Would you like to control over how you pay for healthcare? A health savings account (HSA) affords you this flexibility.
Steps to sign up: 1. You need to be enrolled in a high deductible health plan. 2. Sign up for health savings account with a vendor. Popular choices include HealthEquity, Optum Bank, and HSA Bank. 3. Fund the plan. If you sign up through an employer, you can set up automatic payroll deductions. Advantages of HSAs include: 1. Tax advantages: HSAs are triple-tax free: No taxes are paid upon deposit, accumulation, or withdrawal. 2. Control over your healthcare spending: Use your HSA funds as you'd like. They are generally valid for office visits and prescription drugs. Most seniors should enroll in more cost-effective drug plans. [1] We can help most seniors with their decisions for a couple reasons:
1. Drug plans have complicated designs: Prescription plans intend to cover some initial costs that a senior faces and nearly everything if costs exceed a threshold. Many seniors find themselves responsible for much of the costs in between. Most seniors have trouble making the best choice in the face of such a complex menu of costs. 2. More seniors need to be aware of help we offer: Tools can help seniors estimate the total annual costs given the prescriptions they take. For example, one can save money by using the online tool GoodRx. Use this site to shop around for the cheapest source of prescription drugs. Feel free to contact us if someone you know needs help. We can help Medicare seniors make decisions to save money and stay healthy. [1] "To Switch or Not to Switch: Are Medicare Beneficiaries Switching Drug Plans to Save Money?” Web. 27 September 2015. http://kff.org/medicare/issue-brief/to-switch-or-not-to-switch-are-medicare-beneficiaries-switching-drug-plans-to-save-money/ We are now in the Medicare open enrollment period for the 2021 Plan Year.
A couple keys for this year: 1. The open enrollment period will be between October 15-December 7, as in prior years. This is the period in which you can switch Medicare Advantage Plans starting with a January 1, 2021 effective date. You can also elect to switch from Original Medicare to coverage under a Medicare Advantage plan. 2. Pay attention to changes in plans available. Insurers change plan premiums and benefits each year, so be on the lookout for any changes. Medicare Part B premiums are expected to increase, although the increase might be capped this year due to legislation. Consider your budget and needs when choosing among plans. |