The annual window each year to change or drop a Medicare Advantage Plan (Part C) or Prescription Drug Plan (Part D) begins October 15th and ends December 7th. If you are already enrolled, you can easily just renew your current plan. However, your circumstances and/or coverage may have changed. The rules can be confusing and assuming things will stay the same could be costly. This means that you will need to really evaluate your plan to make sure you are maximizing your benefits. Here are 10 common questions (with answers) we get from clients when evaluating Medicare Plans During AEP
1) How much are premiums, deductibles, and other costs?
- Costs are listed in the plan descriptions and Annual Notices of Coverage
- Costs change annually
- Be sure to review potential changes in cost
2) What if you already have coverage?
- Usually, before October 1styou will receive an annual notice of the change and/ or Evidence of Coverage from your plan for review
- These notifications update any changes in plan costs, benefits, and/or rules for the upcoming year
3) Does the plan you want to fit your budget?
- A Medicare professional is also a local agent that can help you with the answer to this and search for a plan that fits your unique needs
- Financial assistance is available for low-income households
4) Will your doctor or hospital participates in your plan?
- Some doctors take Original Medicare, but may not take part in Medicare Advantage Plans
- Check on your plans provider directory to see if they are in-network
5) How do referrals work?
- Some Medicare Advantage plans may require a referral from your primary Dr. before seeing a specialist
6) Do you have to use specific providers from a network?
- HMO type plans coordinate care and often require you to seek care from providers in your network
- HMO type plans may require you to pick a primary care doctor
7) What if you have another coverage, like employer, COBRA, or retiree?
- If you are age 65 and have employer coverage, you can wait to sign up for Medicare without penalty, but you must sign up within eight months after that employment or coverage ends. The coverage must be considered credible coverage by Medicare
- According to Medicare rules, COBRA insurance does not count as “creditable coverage”
- An employer may provide Retiree insurance as a form of health coverage to former employees.
- The rules in this area are complex and you may want to seek advice from your Medicare Insurance professional if this is applicable to your situation
8) Does your plan cover what is important to you?
- You can review the summary of benefits and coverage that lists what each Medicare Advantage plan covers
- Plans have differing cost-sharing, so if specific services or items are important to your care, ask the plan provider, or your Medicare Insurance advisor for more information
9) Is there a yearly limit you pay out of pocket?
- Medicare Advantage plans are required to set an out-of-pocket maximum. This is the total dollar amount you might pay for covered services during the plan calendar year
- There is no out-of-pocket limit set on Original Medicare, which can place individuals in a difficult financial situation if they only have Original Medicare
10) Will the plan cover you if you travel? (Nationally or Internationally)
- If you are using an approved provider, Original Medicare covers services, regardless of location within the USA
- Medicare Advantage plans may charge more for out-of-network care or may not cover you at all outside your state of residence except in an emergency
- It would be judicious to purchase an international policy for foreign travel
- If you split your time between states or travel extensively, make sure you have a good understanding of your plan selection
Any changes you make during the AEP will take effect on January 1 of the following year.
We hope these 10 AEP questions with answers have helped you. If you have more questions, please feel free to contact us with any questions. We are here to help!
*Medicare Insurance Specialty Group is Not Approved By, Endorsed By, or Affiliated With A Government Agency.