Autumn shows us how beautiful it is to let things go.” – Unknown
Medicare fall annual enrollment, however, is one thing we don’t want to let go of, but rather, let’s embrace it.
For those 65 and older, this is your time to make things right again. If you don’t like your drug plan or advantage plan, you can make changes between Oct. 15 and Dec. 7.
“But I like my plan,” I hear some say. Even if you loved your advantage or Part D drug plan this year, doesn’t mean you’ll love it next year. In two weeks, your Annual Notice of Change (ANOC) will be mailed to you. Expect it in your mailbox between Sept. 19-30.
The ANOC explains changes in coverage, costs, or doctor networks that will take effect Jan. 1, 2023. The ANOC letter is only for Medicare Part D drug plans and Medicare Advantage Plans.
Medicare Supplements or Medigap plans are not included in ANOC because Medicare standardizes the included benefits, which means Medigap benefits don’t change each year.
Keep in mind it’s common for drug plans to be dropped or revised, which can lead to automatic enrollment in a drug plan from the same company. It’s also common for a drug formulary change, meaning a drug that costs you $4 this year might cost you $45 next year.
It’s crucial to read through your ANOC to have a clear understanding of how you will be impacted by plan changes. Even if your plan is not changing, or you’re OK with the changes, you should shop the market and ensure you still have the best plan based on your needs.
In Beaufort County last year, the majority of advantage plan companies had a maximum out of pocket of $7,500 per year. Maximum out of pocket is the most you have to pay for covered services in one year. After you spend $7,500 on deductibles, copayments, and coinsurance for in-network costs, the plan pays 100% of the costs for remainder of the year.
Last fall, there was one PPO advantage plan, Humana, offered with a maximum out of-pocket of $3,400 – half the cost of its competitors. Don’t get sucked into free teeth cleanings or $200 in eyewear. Look at what matters: the provider network, drug costs and – last but not least – the plan’s max-out-of-pocket.
“Autumn is a second spring when every leaf is a flower.” – Albert Camus. My advice: Turn your fallen, dead advantage plan into a flower and consider a Medigap Plan N with a stand-alone drug plan.
Take back control of your healthcare options rather than let an insurance company dictate which doctor or provider you can see. Last year we saw 11 clients get denied for routine medical procedures their doctors deemed necessary, yet the insurance carrier denied them.
We successfully appealed all of them, but ask yourself, why were they even denied initially? Let’s turn fall enrollment into a second spring and put YOU back in the driver’s seat, rather than the insurance company.
Chris Dewey is the founder of May River Medicare Insurance in Bluffton.