KEY
POINTS
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Medicare (AEP) is the Annual Enrollment Period between October 15 and December 7 when Medicare beneficiaries can change Medicare plans without any special eligibility qualifications.
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Specific enrollment options Medicare enrollees can make during AEP depend on their current Medicare coverage.
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Most Medicare Advantage beneficiaries (7 out of 10) fail to review their existing plan against new plans and forego possible coverage improvements or savings.
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Medicare and Daylight Savings Time: Both enacted into law 57 years ago.
Every year, the end of Daylight Savings Time (“Fall Back”) is a reminder in early November to tend to a handful of critical to-do tasks around the house such as replacing the batteries in your smoke and carbon monoxide detectors, cleaning rain gutters ahead of winter storms, and replacing household air filters. To the 65 million Medicare beneficiaries, TrustMedicare.com is using the end of Daylight Savings Time (Fall Back) as a necessary time frame to perform a quick review of Medicare plans within the next 30 days. Appropriately, the U.S. government standardized “Daylight Savings Time” in April of 1966, less than nine months after Lyndon Johnson signed Medicare into law in previous July. That was 57 years ago.
AEP (Annual Enrollment Period) is the Best Time to Compare Medicare Advantage and Medicare Part D Plan Options
Each year, Medicare beneficiaries can review their coverage options and change plans during the Medicare Annual Enrollment Period (AEP) between October 15 to December 7. AEP is a set time every year when Medicare beneficiaries can change Medicare coverage choices. In 2022, Medicare beneficiaries had an average of 39 different Medicare Advantage plans and 23 stand-alone Part D prescription drug plans available to them.
According to the Kaiser Family Foundation, only 32% of Medicare Advantage enrollees compared Medicare plans for coverage during AEP. Moreover, only 18% of MA-PD (Medicare Advantage Prescription Drug Plan) enrollees compare their plans annually.
“I remind my customers who have intensive Part D plan needs and budget constraints, that their current plan isn’t the only one to raise or lower costs or benefits; other plans are on the change as well and should be considered as a new and better option for the next calendar year. Inversely, if we compare plans and determine they have the best possible coverage for their needs, then we’ve done our job as intended and provided confidence in renewing in the same plan into the next coverage year.” Arizona-based agent of 15 years.
It is a common practice for Medicare agents to inquire about an individual’s changing health conditions over the previous year, as their specific pharmaceutical Part D needs may be better served with another plan and affordable formulary.
The Specific Enrollment Options Medicare Enrollees Can Make During AEP Depend on Their Current Medicare Coverage
Current Coverage: Medicare Advantage plan (Part C) with Built-in Part D Drug Coverage
- Switch to another Medicare Advantage plan, with or without a Part D drug coverage.
- Return to Original Medicare. Enrolling in a stand-alone Part D drug plan is an option with Original Medicare.
- Make no changes and renew as is.
Current Coverage: Medicare Advantage (Part C) with a Stand-Alone Part D Drug Plan
- Switch to another Medicare Advantage plan, with or without built-in drug coverage.
- Switch to another stand-alone Part D prescription drug plan. Dropping the stand-alone plan may be an option as well.
- Go back to Original Medicare, and possible review another stand-alone Part D plan.
- Make no changes and renew as is.
Current Coverage: Original Medicare (Parts A & B)
- Enroll in a Medicare Advantage plan (Part C), with or without built-in Part D drug plan.
- Enroll in a stand-alone Medicare Part D prescription drug plan.
- Make no changes and renew as is.
Current Coverage: Original Medicare with a Stand-Alone Part D Prescription Drug Plan
- Switch to another Medicare Part D prescription drug plan.
- Enroll in a Medicare Advantage plan (Part C), with or without built-in Part D drug plan.
- Be done with Medicare Part D prescription drug coverage completely.
- Make no changes and renew as is.
Working with Licensed Insurance Agents and Reviewing Existing Medicare Coverage and Needs
An annual review of your Medicare coverage with a licensed agent should take no more than 30 minutes. Most importantly, be prepared to have an informed discussion with Medicare agents. Before you compare plans and speak with a licensed Medicare agent, make sure you understand your existing Medicare coverage, your unique health insurance needs, and create a list of your medications and preferred doctors, specialists, labs, hospitals, and other health-related services.
This will empower the ability to perform an apples-to-apples comparison of other Medicare plans and options available in a specific geographic area.
“Depending on where an enrollee resides, there are significant changes within provider networks all the time, and this means that Medicare beneficiaries lose access to preferred doctors or even changes in the covered drugs and cost-sharing results in surprise out-of-pocket costs. This is why it’s critical to not be passive and simply automatically renew last year’s coverage.” Orlando-based Medicare agency owner.
Helpful Questions to Ask a Medicare Insurance Agent During Plan Review:
Medications:
- Will the plan cover all of my medications next year?
- Are their any coverage restrictions on my medications such as needing a pre-authorization or a certain quantity limit?
- Relative to my existing medications, what are the price differences between generic and brand-name drugs?
- How much are the premiums and deductibles?
Network of Doctors and Hospitals:
- Will my preferred doctors and hospitals be in the plan’s network next year?
- Will I need a referral to see a specialist?
- What are the out-of-pockets costs, and what’s the maximum out-of-pocket costs?
- How much are the copays, and what is the deductible?
Related Medicare Study Resources:
