Medicare Open Enrollment starts tomorrow. Are you ready?

According to Medicare, each year, health plans and Part D prescription drug plans can change their premiums, deductibles, cost-sharing and some benefits, or discontinue their coverage altogether.

If you have a Medicare Advantage or a Part D prescription drug plan then there may be important changes that will occur at the end of the year.  And if you don’t understand those changes you may be stuck with a plan that does not work the way you think.  Your opportunity to change plans ends December 7th of this year.

This is a short list of some of the things that may change at the end of this year with your plan.

  • The drug formulary (listing of medications the plan covers)
  • The network of providers and pharmacies
  • Your out-of-pocket costs (co-payments, coinsurance)
  • The annual out-of-pocket maximum spending limit
  • The annual deductible
  • The monthly premium

Each year these drug lists are reviewed and some drugs are removed from the plan and sometimes others are added.  Also they can be moved to a higher or lower tier meaning your co-payment could increase or decrease so it really is wise to check to make sure your medications are not effected.  Coverage rules for medications (quantity limits, step therapy, prior authorizations) can also change.

The other and more important answer is to be a wise shopper.  If you are currently on a Medigap plan or Medicare Supplement plan you most likely pay a larger monthly premium than you would with a typical Medicare Advantage plan so it would be wise to at least exam these plans and see what the cost savings might be.   Medicare Advantage plans also sometimes have additional benefits beyond what Medicare offers such as dental, vision and hearing coverage and also money to pay for your vitamins.

Prior to the Annual Open Enrollment Period, your Part C Medicare Advantage or your Part D drug plan must send information about changes in benefits and costs for the upcoming calendar year.  It is very important to take the time to study that information.  If you have concerns I suggest you call the Member Services number on the back of your insurance card and a representative there can answer your questions.  It may also behoove you to meet with a licensed health insurance agent if you have someone that you know and trust to see what other plans are available.  I suggest meeting with an agent because agents are trained and tested on these plans before they can talk about them so they may be able to offer you additional insight on some benefits you could overlook when shopping alone.

If you are the independent sort, as are most folks from New England, than you can find all the Medicare Advantage plans for the 2014 year listed in an easy to compare format at the back of your Medicare & You Handbook.  Medicare sends these out to beneficiaries every year so if you did not get your copy just call 1-800-MEDICARE and they will send it out to you.  You can also use the Planfinder Tool on the website to compare plans.

You can make a change anytime between October 15 and December 7 each year.

If you live in Maine or New Hampshire I would be more than happy to meet with you and help you find a plan that may cost less or offer you better coverage than your current plan.   And if you have any questions you can reach me by telephone at (207) 370-0143 or you may contact me through my website at