Medicare Open Enrollment Is Coming Soon

Medicare_Open_Enrollment_2021

It is that time again – the time to remind anyone who wants to review or change their Medicare coverage that Medicare Open Enrollment is almost here.  If you are on a Medicare Advantage Plan or if you are on a Medicare Supplement but have prescription drug coverage under Medicare D, Medicare Open Enrollment is the time when decisions are made regarding certain Medicare plans for the next year.  Open enrollment for 2021 will begin on October 15 and will continue until December 7, 2020.

Soon you will like receive many glossy flyers that, honestly, often do not help in decision making.

Here is what you need to know.

First, of course, the choice of insurance plans is complicated.  Second, decisions will not always be based on the cost of monthly premiums.  You need to also consider the cost of prescription drugs you are using and on what tier they are placed or whether they are considered specialty drugs.  Generally speaking, if you have a Medicare Supplement plan it has certain advantages over a Medicare Advantage plan especially if you might move or become seriously ill.

  1.  If you are happy with what you have and are currently on a Medicare plan generally speaking you do not need to change.  As with everything there are exceptions.  Premiums could have increased substantially or the plan you are on could have changed its benefits.  Also, medications you use might not be listed on the new formulary for the plan. These are a few examples so you want to take a look at what you have.  If you are thinking of changing, consider carefully what you would be changing to.  Consult with a specialist if necessary.
  2. Before making any decision recognize what kind of plan you are on.  If you are 65 or over, for instance, and especially if you still work full time for a larger employer it is quite possible the employer’s plan is primary and Medicare is secondary and you do not need to make any major decisions at this time.
  3. If your coverage is through yourself individually, know whether you have basic Medicare only or basic Medicare with a Medicare Supplement (Medigap) or if you have a Medicare Advantage plan.  It is not always easy to tell.  If your medication is included in the same plan as your doctor’s visits and hospitalization it is likely a Medicare Advantage plan although Medicare Supplement plans often pair with another company for their prescriptions.  If you have letters associated with your plan like G, H, N, etc. it is probably a Medicare Supplement (look at your insurance card).  If you have extras like dental, vision or Silver Sneakers, it is probably a Medicare Advantage plan.
  4. Once you know whether you have a Medicare Supplement or a Medicare Advantage, here are some of the considerations.

Open enrollment is primarily to determine whether you want to change from one Medicare Advantage plan to another Medicare Advantage plan.  You can also change from one Medicare D (prescription drug plan) to another.

One exception, if you are just turning 65, you can sign up as soon as you become eligible, not just in October until December, and can choose whether you want a Medicare Supplement or a Medicare Advantage plan.   This is a window of time.

Later, if you already have a Medicare Advantage plan and want to change to a Medicare Supplement, you may need to pass medical underwriting to qualify for the Medicare Supplement.

Sometimes individuals sign up for Medicare Advantage plans recognizing the premiums are often lower.  When the same individual becomes seriously ill, he or she may discover that their Medicare Advantage plan is limited or is not accepted by certain doctors or hospitals.  Medicare Advantage plans are limited to a given geographical area.  So, if you have a plan in Pennsylvania and move to Ohio, for instance, you may need to apply for a different plan.  Medicare Supplement insurance is accepted by any doctor or hospital that accepts Medicare.

If you are confused, get help.  The Chester County APPRISE program staffed by volunteers, is excellent.  It can be contacted at 610-344-6035.

About the Author Janet Colliton

Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.

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