It’s time for the annual Medicare Open Enrollment (October 15-December 7). Any changes current Medicare beneficiaries make during the Medicare Open Enrollment will take effect on January 1, 2017. If no changes are made, 2016 plans will carryover into 2017. Get your favorite beverage and sit down at your networked computer for about 30-45 minutes and follow by step-by-step guide to optimizing your Medicare health coverage for 2017. If you have a family member or friend who is not computer savvy, offer to help them. The knowledge you gain in this exercise is eye-opening.
By following the instructions in this blog post you will have at your disposal all the choices you need for evaluation. In a few subsequent blog posts, I will go through the evaluation I perform when making choices for my 80+ year old mom.
I NEVER let my mom’s 2016 Medicare health plans carryover without a reevaluation–people who carryover are asking for costs that are higher than they could be. Health insurance companies work diligently and precisely to capture maximum income and profits from their products. They are constantly changing their plan specifics (e.g., formularies, network doctors or pharmacies, premiums, and cost share) so your current plan is likely to have changed in ways that will end up costing you more than you expected. My mom would be paying a lot more today if I didn’t reevaluate every year. Unlike last year when I only changed her stand-alone Part D Prescription Drug plan, I also plan on looking more closely at Medicare Advantage versus original Medicare options.
While cost is the biggest motivator for reviewing my mom’s Medicare choices every year, my final evaluation must take into account several non-monetary factors as well. For example, my mom loves her family doctor and a change at her age would be disorienting and ill-advised. My mom has high blood pressure and my choices must not introduce undue stress on her. While lower premiums (i.e., upfront) costs, may be tempting, they must be weighed against many other factors, especially for a person who is over the age of 80 like my mom is. My annual Medicare health plan review will include a final decision phase which will be presented in a later blog post.
What Can I Do During Medicare Open Enrollment?
During the annual Medicare Open Enrollment, current Medicare beneficiaries have from October 15 through December 7 to review and make changes to their Medicare coverage. During Medicare Open Enrollment, you can do the following:
- Switch from Original Medicare (Part A and Part B) to a private Medicare Advantage plan (Part C)
- Switch from a private Medicare Advantage plan back to Original Medicare
- Switch from one private Medicare Advantage plan to another if available
- Join, drop, or switch a Medicare Prescription Drug (Part D) plan
If you are signing up for Medicare (Parts A and/or Part B) for the first time, you cannot do so under Medicare Open Enrollment. The government has a different process when eligible Americans first join up.
For people who have a Medicare Supplemental (or Medigap) policy, remember that a Medigap policy can only be used with original Medicare and not with a Medicare Advantage plan. Any evaluation between original Medicare and a Medicare Advantage plan must include Medigap-related consequences. For example, if a person leaves original Medicare for more than 12 months and then wants to go back later, their guaranteed issue rights will have lapsed. This means that the health insurance company can look at your personal health situation when determining how much it charges you for a new Medigap policy and if you are in poor health at the time, your Medigap premiums will be very high or the insurance company can choose not to cover you.
If you have employer (or union)-sponsored retiree health benefits, joining a Medicare Advantage plan could affect those benefits. Always talk to your employer or union benefits administrator about their rules before you look at a particular Medicare Advantage plan. Some retiree health benefits today actually lock beneficiaries into a specific Medicare Advantage plan if they want to continue receiving the retiree benefits.
Any changes you make during the Open Enrollment are locked in for the entire 2017 unless you quality under Special Enrollment Periods. If you have second thoughts about a private Medicare Advantage plan, you can disenroll during the Medicare Advantage Disenrollment Period (Jan. 1 – Feb. 14) and be enrolled in original Medicare (not another Medicare Advantage plan). You can also pick up a stand-alone Medicare Prescription Drug (Part D) plan during this disenrollment window.
Medicare Open Enrollment: Let’s Get Started
On the web page that appears, input your zip code (see figure below).
I entered my mom’s zip code under General Search. Since the only personal data I will be entering will be my mom’s prescription drugs without her name attached, I am not worried about internet privacy breaches in this case. If you choose to follow the Personalized Search pathway, you will end up at the same spot I do; namely, with information about the Medicare plans available in your geographic area. When done, click on Find Plans (in the above figure) and get ready to enter your prescription drugs (including the doses).
We are now ready to follow the government’s easy four step process to finding the Medicare plans available to you.
Step 1: In this first step of the process, you are asked questions that make sure you are a current Medicare beneficiary. I do not answer the optional questions because they require time and I wish to see all possible plan choices this search generates. The second question identifies government programs that restrict your Medicare health insurance choices. If any of these descriptions pertain, be sure to click on it. I clicked on the boxes identified in the figure below. Press Continue to Plan Results.
Step 2: You are now given the opportunity to enter all the prescription drugs you currently take (see the left side of the figure below). An accurate list can be saved and given a Drug List ID and Password Date for retrieval at a later date (see right arrows in figure below). This list can be edited if your prescriptions have changed since you last created the list. Copy the ID and password so that you do not have to input your individual drugs again. If you do not put in your drugs, you will not be able to identify the drug plan formularies that best match your drug list.
After entering all your prescriptions or retrieving the information in your saved drug list, you will see the following result page (I have hidden the specific drug list I generated to protect my mom’s privacy).
If you wanted to add (or remove) a drug that you know you will (or will not) be taking in 2017, alter the list to reflect next year’s drug needs. If all the information is accurate, click on My Drug list is Complete at the bottom of the webpage and continue to the next step.
Step 3: Where you get your prescriptions. Select two (the maximum allowed) pharmacies even if you currently use one for all your prescription needs.
It is important to understand that Medicare prescription drug plans negotiate for volume pricing with specific retail drug stores. Your costs at one retailer could be vastly lower than your costs at another one. Because you do not know which retailers have teamed up with which drug plans at this point in your evaluation, it is important to pick at least one major retail chain for comparison pricing. Many Medicare drug plans also have lower costs through mail order pharmacies which will be seen after we get plan information. After you are satisfied with your selections, click on Proceed to Plan Results.
Step 4: As shown in the figure below, I am greeted with 23 stand-alone Prescription Drug plans, nine Medicare Advantage plans with prescription drug coverage (MA-PD), and only one Medicare Advantage plan without drug coverage (MA). After selecting all of the plans, I am ready to Continue to Plan Results.
In my next blog post, we will start analyzing the information in the plan results generated. My analysis will be in two parts. In the first, I will assume my mom will be keeping her original Medicare and I will simply decide which of the 23 stand-alone drug plans is the best value. In a subsequent blog post, I will look at the possibility of switching from original Medicare to a Medicare Advantage plan. If I end up choosing the one Medicare Advantage plan without prescription drug coverage (MA) for Medicare Part A and Part B coverage, I will add the stand-alone prescription drug plan I found in my earlier analysis.
I invite you to explore the information you generated from your search. There is a wealth of valuable insights as well as questions you didn’t know you had before. I welcome answering any questions you might have or, if I cannot, I will direct you to someone who can.
Where To Get Unbiased Medicare Plan Advice
BB’s Medicare Open Enrollment: Stand-Alone Prescription Drug Plans –assuming mom stayed with original Medicare
Zeroing In On The Cheapest Medicare Part D Plan –assuming mom stayed with original Medicare
BB’s Medicare Open Enrollment: Medicare Health Plan Choices–BB collects information about the Medicare Advantage plans available to her mom
Evaluating Medicare Choices For Mom–Conclusions –learn why my mom chose to stay with original Medicare + Medigap F policy + the cheapest stand-alone Part D plan instead of changing to Medicare Advantage