- Medicare’s annual open enrollment program lets you shop for health and prescription drug coverage for the coming year.
- This year there’s even more reason to check whether your current plans offer the best coverage for you, experts say.
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Medicare beneficiaries have until December 7 to change their Medicare health and prescription drug coverage for next year through annual open enrollment.
This year, there’s even more reason to pay attention, as financial support for prescription drug coverage will be expanded starting January 1, according to Meena Seshamani, director of the Center for Medicare at the Centers for Disease Control and Prevention. Medicare and Medicaid Services.
“It’s important for people to check to see if they qualify for financial assistance to help pay premiums, pay co-pays,” Seshamani said.
Starting in 2024, she noted, people facing high prescription drug costs won’t have to pay anything out of pocket when they reach the catastrophic stage in their benefits, thanks to the new law. prescription medicine.
Notably, Medicare beneficiaries using insulin currently pay no more than $35 per month for covered prescriptions. Seshamani noted that they can also access recommended vaccines at no out-of-pocket cost.
There are other reasons why Medicare beneficiaries should pay attention to annual enrollment this year.
“Medicare open enrollment is important because options change every year, and people’s health needs and their financial situations change every year,” Seshamani said.
For the beneficiary, this is an opportunity to save.
“You’re never locked up for longer than 12 months,” said Darren Hotton, deputy director of public health and well-being at the National Council on Aging, an advocacy group for older Americans.
Here are answers to some top questions to help you navigate Medicare’s annual open enrollment this year.
Medicare open enrollment is when beneficiaries can shop for health plans or prescription drug coverage that better meet their needs.
Notably, health and drug plans change every year, so experts say it’s a good idea to review your options to see which plan fits your needs in terms of cost and coverage. insurance, as well as network providers and pharmacies.
Beneficiaries can switch from original Medicare, which is administered by the federal government, to a privately administered Medicare Advantage plan, or vice versa. Additionally, they can switch Medicare Advantage plans, Hotton noted.
Original Medicare includes Medicare Parts A and B. Medicare Part A covers care provided by hospitals, skilled nursing facilities, and hospices, as well as some home health care services. Medicare Part B covers physician services, outpatient care, medical supplies, and preventive services.
You can’t go to Medicare anymore and say, ‘I’m done. I choose something and that’s it’ because that’s always the wrong thing to do.
deputy director for health and public interest at the National Council on Aging
Original Medicare beneficiaries can choose to add prescription drug coverage by enrolling in a Medicare Part D plan or additional coverage for out-of-pocket costs through Medicare Supplement Insurance or Medigap.
Additionally, beneficiaries can choose a separate Medicare Advantage Plan, which offers Medicare Parts A and B and may also include vision, dental, hearing and prescription drug coverage.
“You can’t go to Medicare anymore and say, ‘I’m done,’” Hotton said. I choose something and I’m done’, because that’s always the wrong thing.”
“You need to decide which option is best for you,” he said.
That starts by asking yourself whether you want Medicare with Medicare supplement insurance like your parents had or you want coverage like what an employer can offer, Hotton says.
Much of the decision comes down to coverage and cost. For example, people often change plans to save on premiums, according to Hotton.
The decision also depends on your individual needs when it comes to your care, your preferred doctor or care network, the prescriptions you want covered, and the pharmacy where you usually fill your prescriptions. that medicine.
“Even if you’re happy with your current plan, there may be a better option for you,” Seshamani says.
She notes that there may be new options for you this year, especially as new drug laws take effect. Furthermore, you may qualify for financial aid.
“It’s very important for people to evaluate their options every year, because options change, your health can change, and your financial situation can change,” Seshamani said. .
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To get the best advice, experts recommend consulting trusted sources.
According to Seshamani, beneficiaries can consult directly with the agency through Medicare.gov and 1-800-MEDICARE.
There is also local unbiased help available through the State Health Insurance Assistance Program, or SHIP, through ShipHelp.org.
By making an appointment with your local SHIP office, you can ask a counselor to help determine the best plans for you for the coming year, according to Hotton, the former Utah SHIP director. This can be done in person, over the phone or online. He said the entire process can take as little as 30 to 40 minutes.
A lot of advertisements appear during open enrollment season. Unfortunately, that can also include misleading marketing practices, according to Seshamani.
This helps double-check whether your individual providers and prescriptions are covered under a given plan and how they compare with other offerings through Medicare.gov or your local SHIP office through ShipHelp.org.
When shopping for Medicare insurance, this helps ensure that you get the best advice.
Double-check what any advertisements or sales brochures tell you to do through your own research through Medicare or SHIP.
Also, be wary of who you take advice from, says Hotton.
“What you don’t want to do is jump into a Medicare Advantage plan because your friend said they liked it,” Hotton says.
It also helps to double-check whether the coverage you want can be offered at a lower price elsewhere, he says.
“You’re paying a premium and you want to make sure you’re getting really good coverage,” Hotton said.
Medicare’s enrollment period begins October 15. Although open enrollment will last until December 7, it helps to act sooner rather than later.
“People should not wait,” Seshamani said.
“If you miss the Dec. 7 deadline, you have to wait until the next open enrollment and you could miss out on the opportunity to save money or get better health care for yourself,” she said.
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