Already on Medicare? Start Preparing for Open Enrollment Now

July 7, 2016

by: The My Medicare Matters team

Already on Medicare? We have a task for you. Take 20 minutes today to assess your health and your healthcare spending. Make it a top priority item–skip your daily scroll through Facebook, or that extra episode of your weekly show. It can make a world of difference in the long run.

You may be thinking, “But I already chose my Medicare plan! That sounds boring and terrible! And also, why do I need to think about these things now?” After all, it’s summer! The sun is shining, the flowers are blooming, and the local beach beckons. Who wants to think about healthcare?

The reason is best summed up in three words: “Medicare Open Enrollment.” The Medicare Open Enrollment Period is an annual period of time (October 15 through December 7) when current Medicare users can choose to re-evaluate part of their Medicare coverage (their Medicare Advantage and/or a Part D plan) and compare it against all the other plans on the market. After re-evaluating, if you find a plan that is a better fit for your needs, you can then switch to, drop or add a Medicare Advantage or Part D plan. Medicare Advantage is also known as a “Part C” plan.

What does this mean for you? As a current Medicare user, you are going to start receiving A LOT of mail in October in the days leading up to Open Enrollment. Specifically, dozens of letters and offers telling you to use the Open Enrollment period to drop your current coverage and switch to Company X’s far superior (according to them) plan. In order to determine if any of these offers are potentially a good fit for your needs, you need to establish a baseline. What is working about your current plan and providers–and what could use some improvement?

To start, try assessing the following factors:

  • Overall health: When you decided what kind of Medicare coverage to sign up for, you probably based it on your current health status. Has that changed at all? If you experienced unexpected health situations this year–and struggled to afford your care, and/or did not receive the quality of care you desire–that might be a sign that it is time to find a better plan for your needs.
  • Costs: Again, you may have picked a fairly expensive plan to start off, worrying that you might have an unforeseen health issue. Are your financial circumstances the same? Are you visiting the doctor as much as you anticipated? Or perhaps you are dishing out copays at every turn, and paying deductibles you never anticipated. Is this a one-time thing, or is it a signal of more to come? You may want to switch to a more affordable option.
  • Provider network/plan flexibility: You may have picked Original Medicare when you were doing a lot of traveling, and wanted the flexibility of accessing services all over the country. If you’re staying closer to home now, or if your travel is predictable and limited, you may want to switch to a Medicare Advantage plan. Medicare Advantage plans are usually more restricted in terms of provider networks near home, but may be a better fit for your needs now. Or the opposite may be true–you’re traveling a lot more than you used to and a Medicare Advantage plan is no longer a good fit. Consider your future plans as well. If you’re envisioning lots of long trips abroad as soon as you retire, you may want to switch to a different type of coverage during this year’s Open Enrollment period.
  • Prescription drug benefits: You may have opted not to sign up for Part D drug plan when you first retired, figuring that you would “self-insure.” Are you only taking generics, or has a physician advised you to look into a new brand-name medication? Have you investigated whether you are eligible for VA benefits? Have you looked at any Medicare Advantage plans–which often include drug coverage already? Now is a good time to determine what type of drug coverage makes the most sense for your situation. Almost everyone eventually needs prescription drugs, whether for a minor illness or a chronic condition. If you are not already covered in some way, get covered during Open Enrollment! Be advised, however, that you may be subject to a late enrollment penalty fee for not enrolling in a Part D drug plan when you first became eligible. You should also investigate whether your state has a Prescription Assistance Program. Membership in one of these plans can give you a special opportunity to enroll for drug coverage outside of the Open Enrollment period.
  • Learn more about enrollment rules: It’s a lot easier to switch from a Medigap/Medicare Supplement policy to a Medicare Advantage (MA) plan than the reverse (switching from MA to Medigap). This is because in most states, if you have been enrolled in an MA plan for more than one year, you are unlikely to be able to enroll in a Medigap plan, which helps many people fill the cost gaps in Original Medicare. Before making any decisions about switching your coverage during Open Enrollment, try taking the Medicare Questionnaire for access to fast, trustworthy professional advice about choosing the best plan for your needs.

As with all life decisions, it is best to evaluate your options long before the deadline strikes. You can calmly assess where you stand and take a well-thought-out approach to your situation. So sit down with a glass of lemonade, gather your medical bills, and see if there is anything that needs tweaking. If there is, you have plenty of time to take the 1-minute Medicare Questionnaire, which can help you access free advice from a licensed benefits advisor about whether to change your Medicare plan during the Open Enrollment period. You can also schedule an appointment with your local State Health Insurance Assistance Program to discuss these issues.

And if your current plan is still the best fit, feel free to sit back, relax and soak up some Vitamin D! You’ve earned it.