What’s new for Medicare open enrollment

The Medicare open enrollment period has begun. It’s that time of year starting before Halloween and stretching into early jingle bell season when ads for Medicare plans saturate the airwaves and stuff mailboxes. You would think everyone 65 and older was faced with a crucial, time-sensitive decision. Not true.

The majority of Medicare beneficiaries are enrolled in original Medicare — Parts A and B — and most of them also have a supplemental insurance plan, often called Medigap. If they’re happy with their coverage, they don’t need to make a change during Medicare open enrollment, which runs from Oct. 15 through Dec. 7 each year.

In fact, most Medicare beneficiaries don’t switch plans during Medicare open enrollment. Seven out of 10 beneficiaries didn’t even compare their coverage options during a recent open enrollment period, according to the Kaiser Family Foundation.

But most people who are enrolled in original Medicare also buy optional prescription drug coverage, known as a Medicare Part D plan. And an increasing portion of Medicare beneficiaries — about 48%, based on the latest estimate from Kaiser — choose to bundle their Medicare coverage in a Medicare Advantage plan that usually includes prescription drug coverage and often offers extra services that original Medicare doesn’t cover, such as vision, hearing and dental care.

If you have a Medicare Advantage or Part D plan, the Medicare Rights Center recommends that you review all your coverage options — even if you’re happy with your current coverage — because plans change their costs and benefits each year.

“It may be tempting to simply let your plan renew, but if you don’t spend a little time comparing your options, you may be missing opportunities to save money,” said Louise Norris, a health policy analyst for medicareresources.org. “Doing a little research during open enrollment can help ensure you don’t pay too much in premiums or miss out on a plan that would lower your out-of-pocket costs at the pharmacy.”

Most people will pay $164.90 per month for Medicare Part B next year, a slight decrease from this year, whether they’re enrolled in original Medicare or a Medicare Advantage plan. High-income retirees will pay more.

Each year, Medicare beneficiaries can review their coverage options and change plans during the open enrollment period. Those with traditional Medicare can compare and switch Medicare Part D stand-alone drug plans or join a Medicare Advantage plan. Enrollees in Medicare Advantage can compare and switch Medicare Advantage plans or elect coverage under original Medicare with or without a stand-alone drug plan.

However, it can be tough to switch from a Medicare Advantage plan to original Medicare because Medicare open enrollment isn’t a guaranteed-issue opportunity to enroll or change supplemental Medigap plans. Beneficiaries can apply for Medigap coverage any time, but eligibility is only guaranteed during the initial six-month enrollment period. After that, eligibility can be based on a person’s medical history, meaning that you can be denied coverage or pay more for a Medigap policy. You can call your State Health Insurance Assistance Program to find out whether you will have the right to purchase a Medigap policy during open enrollment, what options you have and what consumer protections your state provides.

The Medicare Rights Center recommends that Medicare beneficiaries read their annual notice of change, or ANOC, document that they should have received from their Medicare Advantage or Part D plan providers by the end of September. It will list changes in your plan, such as the premium and copays, and will compare the benefits in 2023 with those in 2022. Your plan may send your ANOC in an email rather than a hard copy in the mail.

Review your ANOC and pay particular attention to the summary of the new list of covered drugs for 2023, called a “formulary.” You can use the online Plan Finder tool at www.medicare.gov to select the best plan for your needs. You can also call 1-800-MEDICARE to find out which Medicare Advantage and Part D plans are available in your area.

Don’t base your decision on price alone. Check to see whether the plan you’re considering covers all the medications you take. Spouses don’t need to buy the same plan. They should choose the best plan based on their individual needs.

Starting in 2023, copays for insulin for all beneficiaries will be limited to $35 per month. This applies to all insulin coverage by a beneficiary’s Part D plan or under Medicare Part B, which pays for doctors’ fees and outpatient services. However, because the insulin copay limit is new, it won’t be reflected in the Medicare Plan Finder Tool. The Medicare Rights Centers urges people who use insulin to choose a plan based on the price of all other medications they take and separately confirm that their preferred insulin is on the plan’s formulary.

(Questions about new Social Security rules? Find the answers in Mary Beth Franklin’s 2022 ebook at MaximizingSocialSecurityBenefits.com.)