Here’s why you shouldn’t ignore Medicare open enrollment

Medicare beneficiaries have a slim window to review and improve their coverage options and potentially save money for 2023 during open enrollment.

Until December 7, you can sign up, switch, or drop a plan, with the new coverage beginning January 1.

But, if history is to be an indicator, 7 out of 10 of the 65 million Medicare beneficiaries probably won’t bother with running a check-up on their coverage, according to Kaiser Family Foundation (KFF) data, meaning some seniors may miss out on needed coverage due to changing health needs or significant cost savings.

“Everything about your coverage can change — premiums, deductibles, out-of-pocket maximums, provider networks, pharmacy networks — even though it's the same plan name,” Melinda Caughill, co-founder of the Medicare advice website 65 Incorporated, told Yahoo Money. “It’s scary, but people don’t know that.”

Here’s what to know.

Who needs a change

Generally speaking, if you’re enrolled in traditional Medicare with a Medigap supplemental plan that fits your needs, you’re probably off the hook, and there’s no reason for you to re-evaluate or make changes, according to the counselors at the Medicare Rights Center, a national non-profit consumer service organization.

If you’re already enrolled in a Medicare Advantage or Part D prescription drug plan, an annual checkup is essential these days. That’s because health and drug plan costs and covered benefits constantly change from one year to the next or by region and state.

For instance, although the base premium for a Medicare Part D prescription drug plan will be $32.74 per month in 2023, down from $33.37 in 2022, premiums for specific plans and regions vary from year to year and may be higher or lower than this amount, according to KFF research. Even within a state, prescription drug plan premiums can vary.

Remember that moving from a traditional plan to a Medicare Advantage plan might offer cheaper upfront premiums, but you may have fewer choices when it comes to healthcare providers and have a tougher time getting approvals.

For instance, a random review of a sample of Medicare Advantage plans showed that Medicare Advantage Organizations (MAOs) “sometimes delayed or denied Medicare Advantage beneficiaries' access to services, even though the requests met Medicare coverage rules. MAOs also denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules. Although MAOs approve the vast majority of requests for services and payment, they issue millions of denials each year,” according to a report released this spring from the Office of the Inspector General at the U.S. Department of Health and Human Services.

The Center for Medicare Services (CMS) annual audits of MAOs “have highlighted widespread and persistent problems related to inappropriate denials of services and payment,” according to the study.

Last, to reduce Medicare costs including deductibles and copayments, low-income seniors and adults with disabilities may qualify to receive financial assistance from the Medicare Savings Programs (MSPs). Income limits rise each year.

How to start

In September, your current Medicare prescription drug or Advantage plan provider sent you an Annual Notice of Change (ANOC), which hopefully you didn’t ignore or toss out. It spells out any changes in coverage, costs, and specific drug or medication coverages that will be effective in January.

If things have changed since you last checked-up on your coverage from your overall health to whether or not you take a brand name medications, or a growing fistful of prescriptions, it’s time to do some comparison shopping.

The average Medicare beneficiary in 2022 has access to 39 Medicare Advantage plans, so it can take some sleuthing, but the savings can make it worth your while. In general, you want to make sure the plan covers your doctors and other providers in its network, and that the plan covers all your medications and that your pharmacy is preferred and in-network.

“Say your 2023 plan doesn’t include the pharmacy you’re currently using, you’ll need to know that and make a change for next year to one that is,” Caughill said. “That can save you hundreds of dollars. I ran a plan yesterday for a woman who will save $7,000 next year, not by changing plans, but by changing pharmacies.”

Resources

Comparing plans can be a head scratcher, but there are resources out there to help.

The State Health Insurance Assistance Program network (SHIP) provides one-on-one counseling in every state. You can find your local SHIP here. The program is federally funded by the U.S. Administration for Community Living.

The Medicare Rights Center offers a free consumer helpline: (800-333-4114.) You can also contact Medicare directly at 800-633-4227 to find Medicare Advantage and Part D Plans in your area and to enroll directly.

Medicare’s online searchable Plan Finder on the Medicare.gov site allows you to review Medicare plan options, including Medicare Advantage plans, Medicare Part D plans, and Medigap supplemental policies.

“It’s actually a heck of a lot more simple than people think it might be,” Caughill said. “If you can search for things on Amazon, and purchase them, you can use the Plan Finder tool. The other wonderful thing about the tool is that every plan available to you is there. Tools from insurance agents are usually restricted to what they sell."

Kerry is a Senior Columnist and Senior Reporter at Yahoo Money. Follow her on Twitter @kerryhannon

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