The Annual Open Enrollment Period (AEP) for Medicare starts on October 15th and runs through December 7th each year. During this window, you can evaluate your current Medicare insurance and add, drop, or make changes to your coverage if necessary. If you can plan ahead for open enrollment by reviewing your current healthcare needs and making a few lists, then the process of making changes should be a breeze.
During open enrollment you can:
- Switch from Original Medicare to Medicare Advantage or vice versa
- Switch from one Medicare Advantage plan to a different Medicare Advantage plan available in your area
- Enroll in a Medicare Part D prescription drug plan
- Switch from one Medicare Part D prescription drug plan to another
- Drop Medicare Part D coverage
It’s important to note that according to annual enrollment guidelines, the AEP does not apply to Medicare supplemental policies. This means that changes to Medigap are not allowed during this window.
Prior to the annual Medicare AEP, it’s important to review your healthcare and medical needs to determine if you need to make changes to your existing coverage. The following is an annual Medicare checklist to ensure that you are prepared for any changes that may be required during the annual open enrollment period.
Evaluate Health and Lifestyle Changes
The first thing you should do is evaluate how your health has changed over the last year. Start by answering these questions:
- Have you been seeing your primary care physician more regularly for a particular health concern?
- Have you started seeing a specialist?
- Are you taking any new medications?
In addition to evaluating any changes to your health, it’s also important to reflect on physical or lifestyle changes over the last year. Maybe you have recently joined a local hiking club or started taking tai-chi classes in the park. Be sure to document any significant health or lifestyle modifications that have occurred in the last year.
Next, make two lists. The first list should be of the doctors and specialists that provide your care. Be sure to indicate the co-pay or coinsurance for each visit. The second list should be of medications that you take. Next to each medication, you should note the monthly out-of-pocket cost. Remember to include any over-the-counter medications that you purchase regularly.
Finally, jot down the name of your local hospital and any other medical service centers or urgent care facilities you might need to visit.
Review Change Notices for your Current Medicare Policy
Every year your policy provider will notify you in writing of any changes to your current policy. This could include:
- Changes to which service providers are covered
- Changes to in-network or out-of-network coverage levels
- Changes to your policy’s prescription plan formulary
- Changes to annual coverage caps for extras like dental or vision
- Any other benefits that are being added to or removed from your plan
Review your change notices and highlight anything that might negatively impact your current healthcare or any changes that could result in an increase in your out-of-pocket expenses.
For instance, if a specialist that you see regularly is no longer covered by your current plan, you would have to start paying for that specialist out-of-pocket. Alternately, you may need to find someone to replace that specialist within the network of your current plan.
Another example would be if a prescribed medication has been removed from your current Medicare policy’s formulary. A formulary is the list of medication brands and generic medicines that are included with each specific policy.
Either of these types of changes could result in the need to switch to a Medicare plan that better suits your existing health concerns.
Assess Finances and Current Medical Expenses
Now that you have documented your healthcare needs as well as health and lifestyle changes, and you’ve gathered updates to your current policy terms – it’s time to turn to your finances.
Have your finances changed in the last year? Review your annual or monthly budget to determine if there has been an increase or decrease in the amount of funds you have available for medical expenses. When reviewing your finances – answer these questions:
- Does your current budget still allow you to comfortably pay your Medicare plan premiums?
- How has your budget been affected by your current policy’s deductibles, co-pays, and any coinsurance?
Make note of any out-of-pocket medical expenses that have gone up significantly. Pay particular attention to healthcare expenses that could be reduced or eliminated by changing plans.
Finally – Evaluate your Results
Now that you have a clear picture of your current medical needs and healthcare expenses, it’s time to review how well your current policy holds up. Your Medicare policy may be meeting all of your needs within your budget. However, any changes in your health, your finances, or your habits could mean that you can find better coverage for your current healthcare needs.
For instance, have you experienced an uptick in dental visits over the past year to replace old crowns or fillings? If you switch from an Original Medicare plan to a local Medicare Advantage plan with dental benefits, your dental bills could decrease substantially. Medicare Advantage plans also include vision coverage which reduces your annual cost for glasses or contact lenses.
Alternately, have you started taking a prescription medication that has a steep co-pay, or no generic option? Then maybe it’s time to find a better drug plan.
If you need some help in finding the best plan, you have some options.
Attend an Information Seminar or Consult with an Expert
With the myriad of Medicare policy types and coverages available in today’s marketplace, finding the best type of policy for your needs can be confusing. It may help to attend an information seminar to understand more about the benefits of each policy type. You can also reach out to an expert to explain Medicare policy options and differences.
Once you’ve decided to make a change to your Medicare coverage, don’t forget that the deadline to make a change during Open Enrollment is December 7th.