It’s that time of year when you become so overwhelmed by the complexities of Medicare’s alphabet soup that you end up sticking with what you’ve got. This year’s message is, don’t do that. For at least one in three older Americans, and most likely for many more, failing to shop around could be costly. The Kaiser Family Foundation estimates that if you are not covered by a low-income subsidy, your premiums could go up by $60 unless you change plans.
To save you the eye strain, we’ve scoured the web for the best articles, studies and fact sheets, and come up with the main points that you need to be aware of as you consider your options.
What’s the deal with open enrollment?
Between October 15 and December 7 is the only time that you can:
- Change from Original Medicare (parts A & B ) to a private Medicare Advantage (part C) plan or vice versa
- Switch Medicare Advantage plans
- Change your prescription drug (part D) plan, or join or drop one. You can join a Part D plan through February 14.
You can change your Part C and D plans as often as you like during open enrollment. The last options you pick during this period will be the ones that become active on January 1, 2016.
If you decide you want to disenroll from your Medicare Advantage plan and switch back to Original Medicare, you can do so between January 1 and February 14. At this point, you’ll also have to pick a part D plan.
There is no annual enrollment period for Medigap, and rules on when you can enroll without penalty are dictated state by state.
- Part B Premiums have been flat in recent years. They will rise by an estimated 52 percent, up from around $105 to $159.30 per month, for those not covered by the Hold Harmless rule. This rule protects Medicare beneficiaries from premium increases that outstrip the Social Security cost of living adjustment, or COLA. Since there will be no COLA in 2016, those not elgible for the Hold Harmless rule will pick up the cost of increase for everyone else. Click here to see if you are covered by the Hold Harmless rule.
- The Part B deductible is expected to increase to $223.
- More Medicare Advantage plans will offer vision, dental and/or prescription drug coverage, and possibly even gym membership.
- Many more Prescription Drug Plans, or PDPs, will charge a deductible in 2016. More than half of these will charge the maximum allowed, $360. That’s $40 more than last year — the largest increase ever. Still, 33 percent of PDPs will charge no deductible. Is yours is one of them?
- All PDPs will use tiered cost sharing — they’ll classify drugs in five tiers, and almost all will require you to share the cost of the non-preferred brand tiers. Some 40 percent of PDPs will require you to share the costs for their preferred brand tiers, too. That means unless you seek out a plan that works for you, you could pay higher out-of-pocket costs if you use high-cost drugs.
- Compared to 2015, many more — 84 percent — of PDPs will also use tiered pharmacy networks. They’ll offer you lower cost sharing in selected network pharmacies and higher cost sharing in other network pharmacies.
- There will be many fewer low-income no-premium PDP plans. If you receive a low-income subsidy, you might have to switch plans — or you will be reassigned — in order to have premium-free coverage in 2016.
- Some health care providers will stop accepting Medicare or drop/be dropped by Advantage plans.
What Does This Mean for You?
Given that some plans will raise premiums more than others, will add or increase deductibles and out of pocket maximums, it’s in your interest to shop around for the best deal. But based on what’s likely to change in 2016, costs aren’t the only thing you should look at when considering your options.
- Are your doctors and other providers covered by the plan in 2016?
- What happens when you go to a doctor who is outside of your plan’s network? (HMOs tend to be restrictive—they only pay for out-of-network visits in an emergency. PPOs will pay for out-of-network providers, but they will charge you extra.)
- If you use a brand name specialty drug, will a generic option work for you? Ask your doctor. Many insurance companies may not pay for a drug unless you’ve tried a cheaper drug first and/or get prior authorization from your doc. If you are not flexible with what drugs you take, choose a plan that will pay for your specific needs.
- Are the plan’s preferred pharmacies convenient to you? Many plans use preferred pharmacies and if they’re far, you may end up paying much more for your prescriptions.
- Will your Advantage plan offer benefits like dental/vision, or is there one that will? Consider adding these benefits if yours offers them, or looking for a plan that does.
- How does the plan rate for things like customer service? Medicare Plan Finder has ratings. A four star rating is usually good enough.
How to Find the Best Plan for You
- Read the Medicare and You Handbook for 2016. You can find a PDF online; you can also download it to your ereader by clicking here.
- If you want to check out what a Medicare Advantage plan can offer instead, call 800-Medicare to find out what plans are in your area. You’ll receive a list of plans. Check the plan websites to see which best fits your needs.
- If you already have Medicare Advantage, you should have received a notice that sets out any changes in costs, benefits and rules. Read this and then compare your plan with others by using the Plan Finder on medicare.gov.
- Medicare’s Plan Finder can also help you find a standalone Prescription Drug Plan.
- MedicareInteractive.org advises calling the plans you’re interested in to confirm what you’ve read online and make sure the plan covers your providers, drugs and a local pharmacy. “Write down everything about that conversation. In your notes, record the date of the conversation, whom you spoke with, and the outcome of the call. This information may help protect you in case a plan representative gives you misinformation.”
- Need more help? Each state has a State Health Insurance Assistance Program, or SHIP, that provides free help as you navigate the A,B,Cs and Ds of enrollment or re-enrollment. You can find contact info for your state’s SHIP by clicking here and entering your zipcode.
- You can get free counseling through the Medicare Rights Center by calling 800-333-4114.
- MedicareInteractive has a good Open Enrollment summary
- Kiplinger.com’s informative article that focuses on Parts C and D
- Take a deep dive with the Kaiser Family Foundation’s analysis
Got Medicare enrollment or re-enrollment tips? Please share them by scrolling down to the comments section.