5 tips for navigating Medicare Open Enrollment

Posted: October 31, 2018 | Word Count: 630
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Medicare Open Enrollment is in full swing. For most people enrolled in Medicare, the annual Open Enrollment period (Oct. 15 through Dec. 7) is the only opportunity to make changes to your existing Medicare coverage.

Even if you are happy with your Medicare coverage, you should take the time to explore your options. There may be a plan that is better suited to your health and financial needs that could save you hundreds of dollars in the upcoming year. 

During Medicare Open Enrollment, Medicare beneficiaries can switch Part D prescription drug plans; switch Medicare Advantage plans, which offer health (and often drug) coverage through private insurers; switch from Original Medicare, administered by the federal government, to Medicare Advantage; or switch from Medicare Advantage back to Original Medicare. All changes made to coverage during open enrollment take effect on Jan. 1, 2019.

Dan Klein, president and chief executive officer of the Patient Access Network (PAN) Foundation, an independent charitable organization dedicated to helping people afford out-of-pocket costs for prescribed medications, offers the following tips for navigating Medicare Open Enrollment. 

1. Do your homework

Take the time to shop around and understand the benefits and costs of each plan so that you can find the coverage that works best for you. Changes to your health status, doctors or healthcare providers, prescription drugs or budget may mean that your current plan is no longer the most cost-effective choice. Insurance companies can also make annual changes to their plans that might affect the drugs covered, provider networks and your out-of-pocket costs.  

2. Make sure your doctors and providers are in-network

Before selecting a plan, it’s smart to check that your preferred doctors, hospitals and pharmacies are in the plan’s provider network. If you visit a doctor, hospital or pharmacy that is outside of the network, you will likely have to pay more. If your insurance company has changed your plan’s provider network for next year, you may want to use Open Enrollment to switch to a plan that will include your current doctors, hospitals and pharmacies in-network to lower your medical costs. 

3. Make sure your medications are covered

Medicare Part D helps cover the cost of prescription drugs. Many Medicare Advantage plans provide prescription drug coverage as well. It’s important to ensure that your plan covers the medications you need and that the plan’s network of pharmacies makes it convenient for you to access your drugs. Switching prescription drug coverage, or even adding it for the first time, can help make the critical medical treatments you need less expensive. 

4. Assess if the plan is a good fit for your budget

There may be changes to Medicare Advantage and Medicare Part D plans that affect your out-of-pocket costs. Out-of-pocket costs are your expenses for medical care that aren’t reimbursed by insurance. When selecting a plan, you should consider what you will be responsible for paying under the plan, including the deductible, out-of-pocket limit, co-pays and co-insurance. 

5. Determine how you will pay for your out-of-pocket costs

With rising deductibles, premiums, co-pays and co-insurance, the inability to pay is a growing problem for people with Medicare. There may be assistance available to you if you cannot afford the out-of-pocket costs for your prescription medications. You should research your options now.

If you have limited income and resources, you may qualify for a federal Medicare Low Income Subsidy (LIS) — also known as Extra Help — to help pay for your prescription drug costs. You may also be eligible for a patient co-payment assistance program like PAN that provides people with financial assistance to cover out-of-pocket costs for their medical treatments. You can learn more about PAN and patient assistance charities by visiting PANFoundation.org.

By taking the time to re-evaluate your existing coverage and learn about all the options, you can save significantly on your healthcare costs next year.

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