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Have Medicare beneficiaries until December 7th change their Medicare health insurance and prescription drug coverage for the coming year through open annual enrollment.
This year, there are even more reasons to pay attention as financial assistance for prescription drug coverage is set to expand starting January 1st Meena SeshamaniDirector of the Centers for Medicare and Medicaid Services.
“It is important for people to check whether they are eligible for financial assistance to pay premiums and co-payments,” Seshamani said.
Starting in 2024, people facing high prescription drug costs will no longer have to pay anything out of pocket once they reach that point catastrophic phase of their advantagesshe noted, thanks to new prescription drug legislation.
Specifically, Medicare enrollees who take insulin currently do not have to pay more than $35 per month for covered prescriptions. They would also have access to the recommended vaccines without incurring any out-of-pocket costs, Seshamani emphasized.
There are other reasons why Medicare beneficiaries should pay attention to the annual enrollment deadline this year.
“Medicare open enrollment is so important because options change every year and people’s health needs and financial situations change every year,” Seshamani said.
For the beneficiaries, this is an opportunity to save.
“You are never locked down for more than 12 months,” said Darren Hotton, deputy director of community health and human services at the National Council on Aging, an advocacy group for older Americans.
Here are answers to some of the top questions to help you with annual open Medicare enrollment this year.
With Medicare open enrollment, beneficiaries can search for health insurance or prescription drug coverage that better suits their needs.
In particular, health and drug tariffs change every year. That’s why experts say it’s wise to double-check your choices to see which plans meet your needs in terms of cost and coverage, as well as the providers and pharmacies in the network.
Beneficiaries may be able to switch from the original Medicare plan, which is administered by the federal government, to a Medicare Advantage plan, which is privately administered, or vice versa. Alternatively, they could 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. Medicare Part B covers physician services, outpatient care, medical services, and preventive services.
Beneficiaries of original Medicare may elect to receive additional prescription drug coverage by enrolling in a Medicare Part D plan, or additional coverage of out-of-pocket costs through Medicare Supplemental Insurance or Medigap.
Alternatively, beneficiaries can choose a private Medicare Advantage plan, which includes Medicare Parts A and B and may also include vision, dental, hearing and prescription drug coverage.
“You just can’t come to Medicare anymore and say, ‘I’m done. I pick something and I’m done,’ because that’s always the wrong thing,” Hotton said.
“You have to decide which option is best for you,” he said.
“This starts with asking yourself whether you want Medicare with Medicare Supplement coverage, like your parents had, or whether you want coverage like an employer might provide,” Hotton said.
Much of the decision comes down to coverage and cost. For example, Hotton says people often change their plans to save on premiums.
The decision also depends on what you personally need for your care – which doctors or care networks you prefer, which prescriptions you want covered, and which pharmacy you typically have them filled at.
“Even if you’re happy with your plan, there might be a better option for you,” Seshamani said.
She noted that there may be new opportunities for you this year, especially with the new drug law coming into effect. Additionally, you may be eligible for financial assistance.
“It’s very important that everyone evaluates 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.
There is also independent, local help available through the State Health Insurance Assistance Program (SHIP). ShipHelp.org.
By making an appointment with your local SHIP office, you can have an advisor help you determine the best plans for the coming year, said Hotton, a former SHIP director for the state of Utah. This can be done in person, over the phone or virtually. The entire process can take as little as 30 to 40 minutes, he said.
Many ads appear during open enrollment season. Unfortunately, according to Seshamani, this can also lead to misleading marketing practices.
It’s helpful to double-check whether your personal providers and prescriptions may be covered by a particular plan and how they compare to other offerings Medicare.gov or your local SHIP office ShipHelp.org.
When purchasing Medicare insurance, it is helpful to ensure you are receiving the best advice.
Double-check what advertisements or sales brochures tell you based on your own research with Medicare or SHIP.
Also be careful who you take advice from, Hotton said.
“What you don’t want to do is just jump into a Medicare Advantage plan because your friend says he likes it,” Hotton said.
It’s also helpful to double-check whether the coverage you want might be available cheaper elsewhere, he said.
“You’re paying the premium and you want to make sure you’re getting really good coverage,” Hotton said.
The Medicare enrollment period began October 15th. Registration is not yet completed lasts until December 7thIt helps to act sooner rather than later.
“People shouldn’t wait,” Seshamani said.
“If you miss the Dec. 7 deadline, you will have to wait until the next open enrollment and may miss the chance to save money or get better health care,” she said.