Now is the Moment to Review Your Medicare

Open enrollment for Medicare occurs between October 15 and December 7. This is your chance to make sure Medicare is working for you. It is very important that you review your options to make sure you have the right coverage. 

Now is the time Medicare recipients can switch plans, add prescription coverage, or alter their existing policies. Whether you’re new to Medicare or transferring plans, the list below includes the needed information.

What You Need to Know About Medicare Agents

Medicare was not always so complex. Tricia Neuman, executive director of the Program on Medicare Policy at the Kaiser Family Foundation, stated that those who advocate for Medicare for all are likely not envisioning the current system, in which commercial plans play a substantial role in the Medicare program.

Before the adoption of Part D prescription insurance in 2006, most retired Americans were enrolled in traditional Medicare, with the opportunity to join chosen supplemental plans. Since then, the popularity of private insurance companies’ Medicare Advantage programs has risen.

Neuman states that Medicare Advantage programs cover over half of all Medicare recipients.

As a result, a whole industry of Medicare salesmen and brokers aid patients in comprehending their alternatives while profiting from the sale of private insurance coverage.

It is essential to comprehend how they operate.

The consumer does not pay an agent for these services. According to Benjamin Link, a pharmacist and vice president of pharmacy at the Ohio-based drug analytics company 3 Axis Advisors, affiliations with individual insurance carriers may prevent patients from receiving all available options. Link said that you are not browsing the entire market; rather, you are purchasing what they have deemed to be of high quality.

Lisa Miller of Wilmette, Illinois, stated that her mother and others had similar Medicare enrollment experiences in the past.

She said that when you call one place, they are just affiliated with one type of organization or anything, and they do not consider all your possibilities. She feels it is difficult for registrants to know where to go.

Miller asserts that her mother signed up for a plan that charged her hundreds of dollars more for her medications in this manner. According to Link, buyers must be aware of these linkages to make an informed decision.

AARP, a name linked with senior discounts and information, has partnered with insurance provider UnitedHealthcare to promote Medicare plans.

According to Jane Sung, a senior strategic policy consultant at the AARP Public Policy Institute, the AARP brand has been licensed. Nonetheless, the division that sells insurance is entirely separate from the principal organization that delivers Medicare-related instructional materials through its publications.

Can one enroll in Medicare at any time?

Timing is the first step in registering for Medicare, and the seven months surrounding your 65th birthday constitute the initial Medicare enrollment period.

Cobi Blumenfeld-Gantz, CEO of the Medicare startup Chapter, noted that many individuals are unaware of this. Most individuals believe that if they are 65 and still employed, they do not need to enroll in Medicare.

In many instances, this is true; nonetheless, you will be penalized if you delay enrolling in Medicare prescription drug coverage and do not have comparable coverage through your employer.

Medicare Part A and B must provide at least as much coverage as adequate coverage, according to the Centers for Medicare & Medicaid Services. Blumenfeld-Gantz suggests that certain small businesses may fail to meet the standard coverage. Consequently, if you are 66 and work for a tiny company with 15 people that provides health insurance, the government will penalize you, he stated.

Late enrollment penalties endure for life. 

The penalties are in place to encourage people to enroll in Medicare as soon as they become eligible, guaranteeing that the government saves money by enrolling the greatest number of individuals. According to CMS, late enrollment penalties grow with the time you wait to enroll, are added to your monthly premium, and are levied for the life of your coverage.

For most, this means a sentence of life imprisonment. For example, if you sign up for Medicare Part B coverage after the deadline, your annual premium will increase by 10% and remain at that level eternally.

You may use a tool on to determine when you should enroll.

After the first enrollment period, you can make changes twice a year: during the open enrollment period, which begins on October 15 and goes through December 7, and in the Medicare Advantage open enrollment period, which begins on January 1 and ends on March 31. The second provision applies exclusively to Advantage plan holders.

Certain situations, such as migrating to a new state, may allow you to amend your plans outside of certain times.

When selecting a plan, keep the following in mind:

Upon turning 65 and being eligible for Medicare, you have various plan options based on your location. Using the plan finder, a senior in Cuyahoga County, Ohio, can access more than 80 Medicare Advantage plan options.

By putting your prescriptions, preferred physicians, and hospitals into the plan search tool or by working with a broker, you may discover all the plan options accessible in your zip code.

According to Sung, obtaining the lowest price may be the most crucial factor for some individuals, while for others, it may be preserving their specialty.

She said that if you strongly prefer a certain doctor or health care professional who is crucial to you, you should investigate it. Similarly, and perhaps more crucially for most individuals, you should review the plan formularies. You should verify that it is covered if you have a particularly important prescription drug.

According to Neuman of the Kaiser Family Foundation, advantage plans offer several advantages but are less adaptable in terms of which doctors are in-network and which medications are covered.

She stated that the premium is not the only element to consider, as some plans have cost-sharing mechanisms that can make a hospital stay significantly more expensive, for instance. Ensure that you have the correct Medicare plan annually.

Blumenfeld-Gantz noted that we advise consumers to check periodically since their health needs and Medicare plans and formularies routinely change.

Your doctor may be in-network for one year, but the insurance company may renegotiate their contracts the following year and remove him or her from the network. According to Neuman, however, many customers do not utilize the yearly chance to swap insurance.

Medicare beneficiaries are aware that annual registration provides an opportunity to choose alternatives. She added that they are inundated with commercials on television and receive an abundance of marketing materials in the mail. Even though they realize that it is time to compare plans, few do so. She hypothesizes that this is because they do not believe they have the skills or time to undertake more study and make comparisons.

Pre-existing conditions

Customers can choose a Medigap plan that does not require a doctor’s visit at first enrollment.

However, according to Sung, if an individual originally selects a Medicare Advantage plan, they may be denied or charged a fee to switch to Medigap coverage.

Only four states have provisions to prevent this, including Connecticut, Massachusetts, Maine, and New York.