Hello, everyone! You have probably heard the words “Medicare Open Enrollment” over and over again lately from various sources. I think the whole world knows that this is Medicare Open Enrollment period. But what does that mean for you, really? How can you benefit from this period and what things do you really need to know and consider? Hopefully, this information will prove valuable to you.

What is Open Enrollment

Open enrollment is a period of time between October 15th and December 7th every year that you can freely enroll in different specific parts of Medicare. Note that this isn’t all parts (which is where people tend to get confused), but mainly Part C and Part D.  You can change to any Part D plan you like (and I advise checking your prescriptions against plans every year). You do NOT have to be in the same prescription plan the rest of your life.

You can also do the following during Open Enrollment:

  • Switch from Original Medicare to Medicare Advantage
  • Switch back to Original Medicare FROM Medicare Advantage
    • Note that Enrolling into a Part D plan while enrolled in a Medicare Advantage plan will disenroll you from Medicare Advantage.
  • Switch from Medicare Advantage to Medicare Advantage
  • Or keep the same plan.

These changes go into effect January 1st of 2016. Do you know the difference between Medicare Advantage and a Medicare Supplement? They are two completely different animals. Which one works for you?

What is Open Enrollment NOT for

Medicare Open Enrollment is NOT for Medicare Supplements. Hopefully, you have already carefully selected your Medicare supplement so that it will be the right plan for you for the rest of your life. There is no one plan that fits everyone. The good news is that you can research your company’s rate increase history, its rate structure, and its satisfaction rating and switch to any Medicare supplement at any time of the year, as long as you medically qualify. Even if you don’t think you will qualify, it’s good to reach out to companies if you are looking to switch your Medicare Supplement. I know of one particular company that has a simplified underwriting period that is available to seniors between the ages of 65 and 69. Of course, you can go to a Medicare Supplement without any medical questions if you are over 65 and just leaving the workforce.

What you need to do for Open Enrollment

Medicare Open Enrollment 2015There are a few different things you can do during this period. I would follow these in order depending on your situation.

  1. If you are wanting to leave your Medicare Advantage plan, contact Medicare Supplement Agent.
    1. He or she can help you disenroll from your plan to where you don’t have to do much else
    2. They can make sure that everything is disenrolled properly so that you don’t have a gap in coverage
  2. Contact your Medicare Advantage agent if you want to stay in your Medicare Advantage plan.
    1. He or she can get you in the right plan based on your medical and pharmacy needs
    2. You can move smoothly to another plan within your company if you like the company.
    3. Deductibles and networks are changing, so what worked for you this year may or may not be the best fit next year.
  3. Shop around for other Medicare Advantage plans
    1. If you are unhappy with the company you have been with for the past year, you can change to any companyDeductibles and networks are changing, so what worked for you this year may or may not be the best fit next year.
    2. Deductibles and networks are changing, so what worked for you this year may or may not be the best fit next year.
  4. Go to Medicare.gov and enroll in a Part D Plan if you want to go back to Original Medicare without a supplement.
    1. Enrolling in a Part D plan will disenroll you from a Medicare Advantage plan.
    2. Make sure you have your complete list of prescriptions with you so that you can get the best estimates in prices
    3. You can contact an agent that can help you with Part D, but going to medicare.gov first will help give you an idea.
  5. Just leave everything alone.
    1. If you are happy with where you are and your plan will work for you next year with changes in your ANOC (Annual Notice of Change) if you are on Medicare Advantage, then you have nothing else to do.
    2. If you are happy with your Medicare Supplement company and its rate increases (or lack thereof), then you also have nothing to do.

What is Changing In Medicare In 2016

There are some good things and some things that many may not like about the face of Medicare for 2016. Some changes will go into effect immediately while others are changes we will see down the road. Here are some key points for next year’s Medicare changes:

The good
  • Hepatitis C Screenings are covered now!
The Other
  • 30% of the Medicare beneficiaries will see a premium increase this year for Part B
    • If you get Medicare Part B premiums deducted from your Social Security check and there is no cost of living increase, you won’t see this change.
    • If you don’t meet any of the above requirements, you could see an increase of 52% or more. Brace yourselves.
  • The “Doc Fix” law has been signed. In 2020, there can be no new Medicare Supplements sold that cover part B deductibles.
    • Don’t worry, though, because your current plan C or F will be “grandfathered.”
    • Just know that if you are planning on making changes to either of those plans in 2020, you will not be able to.
  • In 2018, if your income is more than $133,500 ($267,000 for couples), you will pay higher premiums

Part D Changes

Medicare Open Enrollment 2015The Good
  • The donut hole (prescription coverage gap) is shrinking! More donut for us!
    • 2015 starts at $2960. Next year it will start at $3,310
      • This means you have to spend more before your lower benefit amount kicks in
      • Your Part D coverage will be more meaningful throughout the year.
    • Catastrophic coverage 2015 starts at $4,700. Next year, it will start at $4,850
  • The amount of coverage during the donut hole is more favorable
    • 2015, currently pay 45% of brand-name drug costs and 65% of generics until you reach the other side of the hole
    • 2016, pay 45% of brand-name drug cost, but only 58% of generic drugs!
  • Premiums remain an average of $32.50 per month
The Other

You need to be enrolled in Medicare in order to have a Part D plan. Either that or you have to have an “opt-out” request on file.

Other information

With all the changes around, it’s hard to have a clear picture of what’s going on with the Medicare Advantage market. Some huge company mergers have either been completed or are underway. If you have a Humana plan, you actually have an Aetna Plan. If you have a Cigna plan, you will soon start seeing Anthem on your statements. This personally concerns me because it means the Medicare Advantage market is becoming less competitive. This means the incentive for keeping premiums low can be disappearing. In fact, a merger that happened in 2008 increased premiums by more than 13%. I hope that this doesn’t happen again this year, but if it does, you have options during open enrollment. *source “Insurance Mergers Will Reduce Competition and Choice” by Dr. Steven J. Stack, MD (AMA).

Another scary idea is that Medicare Advantage members are expected to pay more for a week in the hospital in a certain case than Original Medicare alone. One source states that they are expected to pay over 60% more for a week in the hospital and 20 days in a skilled nursing facility then someone on Original Medicare without a supplement (*source: “Why Are Medicare Advantage Co-Pays So High?” By David Orenstein-Brown (Brown University). This scares me. People enroll in a Medicare Advantage plan in order to save money. This may not always be the case. However, these statements cover a wide range of companies and may not be true for the plan you have chosen. Just do your homework!

I tell you all these things for this purpose: Look at your plan and make sure it’s going to work for you next year. It may have been perfect “THIS YEAR.” But these plans are changing drastically in some cases. Open enrollment is only a couple months long. Please do your homework and reach out to appropriate people.

Act Now!

Please, leave a comment below if you have any questions about any of this. This is a very brief overview and there is a lot more information that you need to know. If you live in Indiana and would like a live consultation, email me at raphael@simpleseniorhealth.com. I am a licensed agent in Indiana focused on education. Have a fantastic Open Enrollment!



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