Stock Groups

Medicare open enrollment starts soon. Why you should pay attention


A female doctor is working alongside a senior patient at a modern hospital / office clinic

Getty Images| E+ | Getty Images

You can find more fun things than reviewing your Medicare coverage.

It’s still about this time of the year. It’s open enrollment which begins Oct. 15th and ends Dec. 7. you can make changesThey will be in effect from January 1. While you aren’t required to do anything — your 2021 coverage generally would continue into 2022 — it’s worth at least checking to see if your current plan remains your best option, experts say.

“Providers may opt in or out of a network plan, or the cost of a prescription drug may be higher or lower, or may no longer be covered,” said Elizabeth Gavino, founder of Lewin & Gavino and an independent broker and general agent for Medicare plans. 

Learn more about Personal Finance
Here’s how many people pay the estate tax
How to get tax-free income in retirement
These tips can help rein in impulse spending

This annual open enrollment period for fall is to add or change coverage regarding an Advantage Plan (Medicare, Part C), and/or prescription drugs(Part D). These parts can be added, removed or changed.

Juliette Cubanski (deputy director of the Kaiser Family Foundation’s Medicare policy program) stated that most beneficiaries do not compare plans.

Cubanski indicated that “that’s an issue, knowing what information we have about any changes occurring from year to year.” Even if your current plan is satisfactory, you should take the time to look for a better plan that meets your requirements.

Remember that even though congressional representatives are debating whether they should add dental, vision and hearing coverage to original MedicareHowever, it is uncertain whether the legislation will pass the entire process. You may also have coverage for these benefits if your Advantage Plan is in place.

This is what you need to know about open enrollment.

Pay attention to who

Nearly 63.3 Million people have Medicare coverage. The majority of them — 55.1 million — are age 65 or older, while the remainder are individuals with permanent disabilities.

The Fall enrollment window is different than your initial enrollment window. It begins three months before your 65th Birthday and ends three to three months thereafter. You must then sign up for Parts A and B. An Advantage Plan, or Part D prescription drugs plan can be signed up by you during the initial enrollment period. These plans are available from private insurers.

However, most beneficiaries are affected by fall open enrollment regardless of the coverage they have chosen. Advantage Plans are more likely to offer Part D, so 26.7 million beneficiaries choose to have their Parts A, B and C benefits delivered by Advantage Plans.

Rest of the population will continue to receive original Medicare (Parts B and A) but may also have a Part D plan. A few people also opt for a Medicare supplement plan, also known as Medigap. This is an option offered by private insurance companies. 

Overall, 48.5 Million beneficiaries receive prescription drug coverage via either an Advantage or standalone Part D plan.

Here’s the nitty gritty

Each year, typically by September 30, your prescription drug or Advantage Plan should mail you a document explaining the changes in the coming year. 

According to Danielle Roberts (co-founder of Boomer Benefits Insurance), this could mean adjustments in monthly premiums and copays.

The average monthly premium for Advantage plans will be $19 next year, down from $21.22 in 2021, according to the Centers for Medicare & Medicaid Services. Average Part D Part D monthly premiums will increase to $33.27 from this year.

Part B monthly premiums — as well as other various cost details — for 2022 have not been finalized yet. The latest Medicare trustees’ report states that the Part B average premium would rise to $158.50, from $148.50 in 2018.

It’s worth taking a little time to see if … you find a plan with better value or coverage for your needs.

Juliette Cubanski

Director Deputy for Kaiser Family Foundation’s Medicare Policy Program

Roberts stated that Part D plans may be in danger of being cancelled.

Your insurance company might terminate your enrollment in any drug plans that are being discontinued. [move you]Roberts stated that they would be glad to help them with any of the other drugs plans.

She said that in some instances, the premiums for other plans may be significantly higher.

Roberts explained that Roberts did not recommend finding out about this information in January, when it is too late to alter your Part D drug plans.

The same applies if you discover too late that your medication does not cover or has a higher out-of-pocket expense.

You can change the coverage of your Advantage Plan between January 1, and March 31, if you decide to enroll in fall and then realize that you don’t like it. Switching to an Advantage Plan, original Medicare or a standalone prescription plan would allow you to do so.

Watch out for Advantage Plans

Although Advantage Plans offered by insurers are federally regulated and subject to certain restrictions, details can differ from one plan to the next, in different counties, or even year to year. You may be able to get additional services such as hearing, vision and dental care.

Cubanski of Kaiser foundation said that it’s not enough to focus only on the monthly income. 

She said that people might be interested in the charges associated with skilled nursing or hospitalization plans. Even if it is unlikely that you will need hospitalization, you should still calculate how much money you would have to pay out-of-pocket if anything happens.

Advantage Plans have out-of-pocket limitations, which is different from original Medicare. This allows you to know your worst-case scenario. However, these limits and other costs-sharing options can differ between plans.

Make sure you check that the network still includes your doctors, hospitals, and other providers. Prescription drug coverage is a good option. Make sure that your prescriptions are not lost.

Do you want an advantage plan?

You can drop your Advantage Plan if it isn’t serving you well and switch to another plan.

If you desire that coverage, your original Medicare would be maintained (Parts B and A). However, you will need to purchase a separate Part D prescription drug policy if it is required. You could get a financial penalty if you decide to go without.

Even though beneficiaries may be eligible to purchase Medigap, certain restrictions apply. You can purchase Medigap in six months if you don’t live in an area with different rules or meet exceptions.

Roberts stated that if underwriting is likely, you should apply early for Medigap policies during the fall enrollment window. He also advised you to keep your Advantage Plan in force until you are sure you have the additional coverage.