Every year at this time – October 15 through December 7 — is the open enrollment period for Medicare.
It is the time when millions of seniors have the opportunity to check out their healthcare coverage to ensure they are getting the most effective insurance for their particular situation.
Many wonder why they need to be concerned. They say, “I am covered already.”
Some seniors don’t realize that they can make changes that could benefit them.
Medicare is more complex than many family caregivers might guess, thus they are leaving it to their seniors without realizing the challenges they face.
Medicare Coverage Options
There are many healthcare options for your senior to consider during this time of open enrollment, some of which may have changed from last year. During the rest of the year, seniors can’t make changes without a good reason.
It is important to understand that, every year, out-of-pocket expenses charged under your senior’s current plan could increase.
Checking to see if the current plan is the most cost effective for not only monthly payments but coverage, caps, and out-of-pocket expenses.
Can your senior still use their current medical team? Is this team still in network? How about the hospital or preventive services testing centers?
Now is the time to compare Medicare Advantage plans and Part D prescription drug plans to determine if there is a need to switch to the one that is a better fit for your senior’s current medical situation. A change in their health status can mean a change in insurance coverage is needed.
Exploring all the options could save hundreds of dollars a year if your senior loved one is not on the right plan now.
Part D Prescription Plans
Part D plans cover the cost of prescription drugs and are administered by insurance companies approved by Medicare.
These plans change from year to year. Which drugs, which dosage, which pharmacy can be used, and the copay costs are different from one Part D plan to another so it is important to compare based on your senior’s current (and potential) medication list.
Another thing to investigate is whether your senior’s prescription drug regimen has changed in the past year.
Are they getting the best price for their current medications? If a drug that was added is not in their current Part D plan, it is a good time to see if another plan will provide more inclusive coverage.
Are their vaccinations covered fully including shingles and pneumonia immunizations? Is it time for a vaccine like shingles? If so, ask if and at what cost these are covered in the current or other plans.
Tools for Seniors and Family Caregivers
To help you learn more about your senior’s current plan and what other options are available, your senior will be getting a notice called the Annual Notice of Change/Evidence of Coverage. This information will help determine if there will be any changes or increases in their coverage and out-of-pocket expenses under their current plan in the upcoming year.
This detailed information should alert you and your senior to do some comparison shopping properly armed with what their current plan will entail. It may be that your senior loved one’s current plan may still be the best option, but you won’t know until you learn more.
Your senior will also receive the Medicare & You Handbook which will inform both of you about what Medicare will cover and not cover in the upcoming year.
Will Medicare cover medical equipment, preventive testing, home care, or hospital stays among other things? Things may be different than they have been in the past so this is important to review before healthcare is needed and the coverage is not available or too costly for their fixed income.
The gap between their expected need and their actual coverage may signal a need for a supplemental insurance plan to help offset possible costs.
Is your senior’s plan rated highly? Has it received a five or three or lower star rating? A five star rating is considered the highest quality plan and three stars are poor quality. If your senior’s plan is ranked in the low range, it is a good idea to investigate a better option before open enrollment closes.
Advice and More Information
If you and your senior loved one have specific questions about Medicare, you can get free advice from a Medicare adviser here.
You can search for a personalized plan using the Medicare Find a Plan site. You will be asked some info about your senior and their location which will help find info for different plans. Be careful not to judge plans solely on monthly premiums because a lower premium could mean less coverage and higher out-of-pocket expenses when healthcare is sought.
All of these tools will help family caregivers become better informed so that they can guide senior loved ones to be sure they are getting all the healthcare coverage they require without breaking the bank.
A little planning time now before open enrollment ends will help you both be better able to weather potential health care storms in the coming year.