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It’s hard to escape the Medicare ads that fill the airways each fall, when insurance companies vie for beneficiaries’ attention during the annual open enrollment period.
Starting Oct. 15 through Dec. 7, the more than 63 million Medicare beneficiaries can pick a new Medicare Part D drug plan, a new Medicare Advantage plan, or switch from Original Medicare into a Medicare Advantage plan or vice versa. Any coverage changes made during this period will go into effect Jan. 1, 2022.
Despite the flurry of ads and public service announcements, most beneficiaries stick with the coverage they’ve got. Seven in 10 Medicare beneficiaries didn’t compare plans during the 2018 open enrollment period, the most recent for which there is data available, according to research from the Kaiser Family Foundation.
This is a missed opportunity, experts say. While it can be tedious to go over your insurance coverage, the effort can pay off in lower costs. Each year, plans are allowed to make changes that could potentially increase your out-of-pocket outlay. Even if your coverage doesn’t change, your needs might. For example, you might have gotten a new diagnosis this year that results in new medications and specialist visits that might be covered more comprehensively under a different plan.
By now, you should have received a notice in the mail from your insurance carrier outlining any planned changes for next year. Here’s what to know about comparing your options, which you can do with Medicare’s Plan Finder tool. If you’d like assistance, you can call Medicare at 1-800-Medicare or contact your local State Health Insurance Assistance Program (SHIP) for unbiased advice.
What’s new for Medicare Advantage
Medicare Advantage is an alternative to Original Medicare. Also known as Part C, it offers care managed by private health insurers that contract with the government. (Aetna, UnitedHealthcare and Humana are among the providers.)
Medicare Advantage plans offer perks that Original Medicare doesn’t, such as limited dental and vision coverage. (There is a proposal in Congress that would provide dental, vision and hearing benefits in Original Medicare, yet there's no guarantee it will become law.) Most Medicare Advantage plans offer prescription benefits, and some offer benefits such as meal delivery and transportation help to qualifying members (check eligibility criteria before you enroll).
The average premium for Medicare Advantage will be $19 for 2022, down from $21.22 this year, the Centers for Medicare & Medicaid Services (CMS) announced. While that’s the average, many Medicare Advantage plans have $0 premiums.
This may make Part C more cost effective than Original Medicare, which beneficiaries often pair with an optional Part D drug plan and optional Medigap supplement plan. But this affordability comes with a trade-off: many Medicare Advantage plans are HMOs with limited networks of doctors and hospitals, so your choice of providers may be limited. With Original Medicare, you can see any doctor in the country who takes Medicare.
If you’re unhappy with your plan's provider network — say you decide to become a snowbird and your new state isn't well covered — pause before dropping your Medicare Advantage plan. If you want to switch to Original Medicare and buy a Medigap supplement plan, keep in mind that these plans are medically underwritten. That means that the insurer reviews your health records and, outside of certain circumstances, you might be denied coverage or charged more based on your conditions. For example, patients battling cancer will likely be unable to purchase new coverage. (Medigap supplement plans are regulated at the state level and aren’t part of open enrollment.) Look into your options and make sure you can secure coverage before dropping your Medicare Advantage plan.
What’s new for Medicare Part D
Many people on Original Medicare choose to buy a stand-alone Part D drug plan to help cover medication costs. The average 2022 premium for Part D coverage will be $33 per month, compared to $31.47 in 2021, CMS announced. But it’s important to look beyond the premium to your total costs, which Medicare’s tool will display if you input your medications. Some plans might have a higher premium but better coverage of your prescriptions, resulting in lower overall costs. “It’s really doing your homework, understanding what’s in your medicine cabinet,” says Gregg Ratkovic, president of Medicare for eHealth, an online broker whose licensed agents help consumers compare their Medicare choices.
Also pay attention to where you fill your prescriptions, Ratkovic says. If you switched pharmacies and your new one isn’t a preferred pharmacy in your plan, that will likely mean higher costs.
Last year, CMS unveiled a new savings program for the one in three beneficiaries with diabetes. The Senior Savings Model, as it’s called, is designed to provide beneficiaries with Part D plans that offer a one-month supply of insulin for no more than $35. That program continues to expand this year, with some Medicare Advantage plans also participating, so beneficiaries who want to take advantage of the program have more options to compare.
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