Open Enrollment – It’s Especially Important This Year
I’ve been involved with advocating for older Americans for almost 30 years and it has always been a tradition, as open enrollment approaches, to urge seniors to review their options when it comes to their healthcare, and you really do have options. One of the things that is unique about our country’s healthcare is our ability to choose. I do realize that everyone becomes eligible for the Medicare program when they turn 65 and we certainly didn’t have a choice when they took the payroll deductions out of our paychecks, but there are options within Medicare that can have a big effect on how we are cared for and how much we pay out-of-pocket as we age. While the basic Medicare is the same for everyone, there are provisions to pay less deductibles and other expenses if you qualify for low-income subsidies. There is also the option to buy supplemental insurance to cover more of the out-of-pocket costs and there are Medicare Advantage (MA) programs, often called Medicare Part C, that can give you more benefits than traditional Medicare including a prescription drug benefit, Part D, often at no extra cost. But there are tradeoffs to consider as you weigh each of these options and this year, more than any other that I can remember, there are changes that warrant our attention.
The open enrollment begins October 15th and ends December 7th is where you can make multiple changes including selecting a MA plan. If you are already enrolled in a MA plan you have an extended period of time, January 1st to March 31st, to change to another MA plan or go back to basic Medicare. If you are just turning 65 click here to find out how to register for Medicare.
I don’t have to tell you that healthcare insurance is complicated. It was complicated when you were younger and enrolled in a commercial plan and it seems to be even more complicated as we grow older. Insurance plans, Medicare included, tries to apply general rules to each of our very unique physical conditions. It’s a difficult balance to try to eliminate excessive and unneeded procedures and medicines while also maintaining accessible, cost effective treatments. I’ll pause here to put a plug in for value-based care, a way to reward quality of care rather than the fee-for-service approach that focuses on the quantity of care, which continues to be the primary method used in Medicare. Value-based care allows the provider to focus on the individual patient and do what is best for that particular person rather than adhere to a series of rules and payments based on general guidelines. You can find out more about value-based care at one of my earlier blogs. While healthcare is complicated it’s absolutely worth the time to do the research and take advantage of the different tools available to help you as you evaluate your coverage during open enrollment.
The important thing is for you to research your options and decide on whether you will stay with the program you have or enroll in one that better fits your healthcare and financial needs. Every year we encourage you to take the time and do the research but, sadly, 7 out of 10 of us don’t actually do it. Those with traditional Medicare are even worse, while those using a Medicare Advantage plan are somewhat better. Here are some reasons and situations that should motivate you to review your coverage.
I’ll focus on those that either have Medicare supplemental insurance or are enrolled in Medicare Advantage (MA) since they make up 95% of those over 65. I’ll also not include those who are signing up for Medicare for the first time. At the end of the blog, I’ll talk about some tools that can help you as you make your evaluation. My assumption is that you’ve chosen your current plan for good reasons and your either satisfied with it or you aren’t.
If you aren’t – then you have some good research criteria to guide you as well as the reasons detailed below. Your research should include both supplemental and MA plans since they have their own strengths and weaknesses and might have the answer to correct your dissatisfaction.
If you are satisfied – consider these good reasons for reviewing your coverage.
· Plan changes – The current administration has made changes that affect Medicare. They have especially focused on Medicare Advantage so you need to research what your MA or supplemental plan will look like in 2026. You know what benefits and coverage your health condition requires, identify any changes that could affect your usage.
· Your changes – If your health has changed then a review of the benefits and coverage in that area is important. The availability of specialists, both in areas of expertise that fit your needs as well as the travel distance are one important thing to consider.
· Prescription drug plans – If you don’t do anything else review your Part D plan. These plans change in some way every year, their formularies or tier status often change and could affect both the availability of a medicine you take or the out-of-pocket cost.
Take the time to do this review.
When the prescription drug benefit was signed into law one of the most important parts of its successful implementation was the State Health Insurance Assistance Program (SHIP). It offers trusted, unbiased, one-on-one counseling and assistance for your search for the right healthcare option for you. Click here to find the contact information for your location. It can really help. Get to them early in the open enrollment period before they get too busy. Another good place to help you is the KFF Medicare Coverage Overview.
I hope you see how reviewing your healthcare options can ensure access to the care you need and very possibly save you money. Don’t pass up this window of opportunity.
Best, Thair