Even Medicare beneficiaries happy with their plans should take the opportunity this open enrollment season to comparison shop – and review their current coverage.
Medicare’s annual open enrollment period begins on Oct. 15 and ends on Dec. 7. This is the time when beneficiaries can switch their insurance plan, or at least review other options available. They may also switch to Medicare Advantage during this period (they can’t make changes to current Medicare Advantage plans – that is a separate enrollment period at the beginning of each year).
But not everyone takes advantage of this time to make a switch. More than seven in 10 Medicare beneficiaries did not even compare plans during this period in 2018, according to the Kaiser Family Foundation, a nonprofit group focused on health policy. Many times, it’s because making the change – or just reviewing the options – can be overwhelming, said Dave Francis, chief executive officer and co-founder of Healthpilot, a company whose services include automated and personalized Medicare plan recommendations.
“The proliferation of plans has created an increasingly large and complex set of decisions,” Francis said. “It is impossible for an expert to manage without the help of sophisticated tools.”
Still, avoiding the task can be expensive – some Americans could save more than $1,000 in some cases, if they were signed up for the right plan, Francis said.
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Switching plans isn’t necessary, but reviewing current coverage should be. Plans change every year, even for beneficiaries sticking with the same one as the year before. Individuals may receive information about these changes to their plans in the mail, or online if they’ve signed up for those notifications, and they’re usually lengthy documents, said Ann Kayrish, senior program manager for Medicare at the National Council on Aging.
Coverage changes may include alternatives to medications, such as a less expensive drug in lieu of the prescription the patient has become accustomed to, or a doctor dropping out of the network. Copays could also change. “These are the kinds of things you need to make sure you’re reviewing each year,” Kayrish said.
The Biden Administration’s Inflation Reduction Act signed into law earlier this year included provisions for Medicare – some of which will be effective as early as the new year. These updates include an insulin cap of $35 per month for patients, as well as making some vaccine shots, such as the one for shingles, free of charge for beneficiaries.
“If you need a vaccine, like shingles – last year, more than 2 million seniors got that vaccine – most of the folks had to pay $100 for that shot. In some cases, $200 for that shot,” Biden said during a September White House event discussing the Inflation Reduction Act. “Do you have any wonder how many seniors skipped that shot? For seniors with disease, it could be because it’s too expensive.”
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Although the insulin cap will be enacted for all Medicare beneficiaries, not all insurance plans have the same types of insulin products – another reason beneficiaries should review current and alternative options, Kayrish said.
Beneficiaries have multiple resources available to them to comparison shop their Medicare plans. Medicare.gov has a search tool, for example, that will explain coverage for 2022 and 2023 plans. BenefitsCheckUp is another program, from the National Council on Aging, older Americans can use to find plans and benefits. Healthpilot’s platform also analyzes Medicare plans available to a beneficiary after asking them what prescriptions or doctors they prefer. Individuals can also consult with a broker who specializes in Medicare options.
When considering a switch, think about what medication you’re currently using – or may be using next year – as well as the doctors, pharmacies, hospitals and other medical facilities you’d prefer to visit. If a medical procedure is expected in the next year, check to see that your current or potentially new insurance policy will help.
“Make sure that you check your coverage and make sure that you’re in a plan that covers everything you need,” Francis said. “If you haven’t checked recently, you may not be covered for what you think you are.”