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By Christian Worstell, licensed insurance agent and Senior Writer for MedicareAdvantage.com
The Medicare Annual Enrollment Period (AEP, also called the fall Medicare Open Enrollment Period), runs from Oct. 15 to Dec. 7. This is the time of year when millions of Medicare beneficiaries may have the opportunity to add, drop or change their private Medicare coverage in time for the 2021 plan year.
For licensed insurance agents like myself, I know that the key to this frantic time of year is preparation. And I also know that preparation can be just as key for beneficiaries.
Below is my AEP checklist to help Medicare beneficiaries navigate their way through this enrollment process and maximize their chances of selecting the best coverage for their needs.
Before you wade into AEP, make sure you address each of the following key factors.
✔ Know the difference in plan types
There are some acronyms that may be helpful to know.
“MA” often refers to Medicare Advantage plans, which are also called Medicare Part C. These plans offer all of the same benefits as Original Medicare (Part A and Part B, which are provided by the federal government). Medicare Advantage plans, however, are sold by private insurance companies and may also cover things like routine dental and vision care, which Original Medicare doesn’t cover.
“MAPD” refers to Medicare Advantage Prescription Drug plans. These are Medicare Advantage plans that also include prescription drug coverage as an added benefit.
“PDP” refers to stand-alone prescription drug plans, also called Medicare Part D plans. These plans offer coverage exclusively for prescription drugs.
✔ Know what’s new in Medicare
New benefits are introduced to Medicare just about every year, and it’s always helpful to know what sort of coverage has been added or expanded for the upcoming year.
Page two of the Medicare & You 2021 handbook lists the new Medicare benefits being added for the 2021 plan year.
Some of the most notable new benefits offered in 2021 include:
- Beneficiaries with End-Stage Renal Disease (ESRD) are now eligible to join Medicare Advantage plans. These beneficiaries were not previously allowed to do so in most cases.
- Acupuncture may now be covered by Medicare in certain situations.
- Telehealth benefits have been added and expanded, partly due to the COVID-19 pandemic.
- A new payment model can offer big savings on insulin for qualified diabetic beneficiaries.
✔ Know what’s changing about your current plan
Beneficiaries who are already enrolled in a Medicare Advantage or Medicare Part D plan will receive an annual notice of change detailing any changes in their plan coverage, costs or conditions for the upcoming year. This letter is mailed out to beneficiaries prior to the start of AEP.
Read this letter carefully, as it will help you determine whether or not your current plan will continue to best address your needs for another year.
✔ Brush up on your insurance terms
Premiums, deductibles, copayment, coinsurance, out-of-pocket limits and more. There are plenty of important terms to know when it comes to reviewing the costs of your Medicare coverage, and it’s important to be familiar with them all.
Our own research found that less than half of Medicare beneficiaries were able to correctly define a deductible and coinsurance.
✔ Have names of your doctors and other health care providers handy
Among the most important things to consider when evaluating a Medicare plan is whether or not your favorite doctor, pharmacy and other health care providers participate in the plan’s network.
Make a list of the names of health care facilities and providers that you frequent so you can easily crosscheck while plan shopping.
✔ Make a list of your prescriptions
Write down the names of all the medications you’re currently taking or have taken in the last year. If you’re considering adding or switching Medicare drug coverage, you’ll want to be sure that any new plan will cover your drugs.
You can find out what drugs a Medicare plan covers by reviewing the plan formulary, which details what drugs are covered and at what coverage level or tier.
✔ Get help comparing your options
Medicare plan shopping can be confusing. In fact, our research found that 7 out of 10 Medicare beneficiaries agree that Medicare insurance is confusing and difficult to understand.
Fortunately, you don’t have to go through Medicare enrollment alone. Your State Health Insurance Assistance Program can offer free and unbiased Medicare advice. A licensed insurance agent can also answer your Medicare questions, help review your needs and ensure that you get properly enrolled in a plan without error, if you’re eligible.
The Annual Enrollment Period can be a crazy time of year, but just a little preparation can go a long way. Good luck out there.
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.