2018 Medicare Open Enrollment: Minimize Costs, Maximize Coverage

medicare open enrollment

Medicare Open Enrollment: Oct 15 to Dec 7

Medicare Open Enrollment is here! Reviewing your older adult’s healthcare plans now could make a big difference in their 2018 costs and coverage.

From October 15 to December 7, people covered by Medicare can make changes to their medical and prescription drug plans for 2018. After December 7th, no more changes can be made for 2018.

It’s important to review your older adult’s current plans because making changes could save money or improve coverage. This is a complex task, but you have until December 7th so don’t feel pressured – and changes won’t take effect until January 1, 2018.

We explain why making a change may be needed, how to know which plan changes to focus on, how to compare 4 key areas of coverage, and 4 ways to get help with enrollment.

Note: Older adults affected by this year’s hurricane damage are eligible for an extended enrollment period that ends December 31, 2017 (more detail).



Why do seniors need to make changes to Medicare plan choices?

Medicare health and drug plans can change each year: costs, coverage, and which providers and pharmacies are in-network.

That means the plan that covered everything your older adult needed this year might not have the same coverage next year. This is especially true for Part D prescription drug plans.

Those changes could result in significant increases in next year’s healthcare costs. But often, changing to a different plan could get the coverage your older adult needs without increasing their premium or out-of-pocket costs.

And there’s always a little hope that there are plans with lower premiums that would offer the needed coverage.


The Annual Notice of Change highlights important changes

To help you focus on key areas instead of having to review the entire plan, look for the Annual Notice of Change (ANOC).

In early October, your older adult should have gotten an annual notice from their current health insurance company. The ANOC should be a thinner booklet that explains changes in prices and coverage for 2018.


Compare 4 important areas of Medicare coverage

1. Premiums
Is the plan premium going up? If the increase is significant, there might be a plan that gives similar coverage at a lower price.

2. Deductibles and co-pays
What are the current deductibles and co-pays? Will these be increasing next year?

3. Prescription drug coverage
Medication that’s not covered is expensive! Paying special attention to prescription drug plans could save a lot of money.

It’s time-consuming, but necessary to find out how changes in drug plan premiums, formulary, and pricing tiers will affect the cost of medications your older adult takes.

Typically, a plan could raise premiums, add or remove drugs from their formulary, change pricing, or move drugs from one price tier to another.

Look up each of your older adult’s medications so you’ll know:

  1. If it’s covered in the plan’s formulary
  2. Which pricing tier the medication is in
  3. How much the drugs in that tier will cost

It’s also important to know if your older adult’s preferred pharmacy is in the plan’s network (prices are lowest in-network) and if there are any restrictions, like prior authorization or being forced to try a certain drug first.

Estimating those costs and taking restrictions into account gives you a clear picture of which 2018 plan will provide the most cost-effective prescription drug coverage.

Note: A plan’s formulary is the list of covered medications. Most prescription drug plans have 5 pricing tiers – preferred generics, other generics, preferred branded drugs, other branded drugs, and expensive specialty medications. Each tier has a different cost.

4. Part C / Medicare Advantage / Managed Care
If your older adult has a Medicare Advantage plan, call their current doctors, hospitals, specialists, and other providers to make sure they’ll still be in the plan’s provider network in 2018.



4 ways to get help with 2018 Medicare Open Enrollment

Comparing Medicare plan options can be overwhelming. Get additional help and information from these 4 reputable sources.

1. Contact the local SHIP office
Getting expert advice can save hours. The State Health Insurance Assistance Programs (SHIPs) give free, in depth, one-on-one insurance counseling and help.

A counselor who understands Medicare and Medicaid can guide to you smart options for your older adult’s personal situation. You can trust them because SHIPs are official government programs that are funded by the federal U.S. Department of Health and Human Services.
Find your state’s SHIP office

2. Contact the local Area Agency on Aging
Call the local Area Agency on Aging and ask if they have programs that help with Medicare Open Enrollment.
Find the local Area Agency on Aging

3. Use Medicare’s online plan finder
Medicare has an online plan finder and comparison tool.

Enter your older adult’s zip code, current Medicare coverage, and medications. Then, the tool shows their available plan options for 2018.
Use Medicare’s online plan finder

Note: There is a separate Medigap Policy plan finder

4. Call 1-800-MEDICARE (1-800-633-4227)
You could also call the Medicare office and ask a representative to run a search for plan options and mail you the results. This takes time, so call ASAP.


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By DailyCaring Editorial Team
Image: HealthPartners


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