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Life Health > Health Insurance > Medicare Planning

Medicare Open Enrollment: A Checklist for Advisors and Clients

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What You Need to Know

  • The Medicare annual enrollment period runs from Oct. 15 to Dec. 7 each year.
  • This is the time when clients already on Medicare can make changes to their coverage.
  • Clients should review changes in their existing plan as well as their health situation to determine if they need to select a new plan.

For clients already enrolled in Medicare, the annual open enrollment period during which they can change their Medicare options is right around the corner. The enrollment period runs from Oct. 15 to Dec. 7 each year.

During the annual enrollment period, clients can change any aspect of their coverage, including drug plans and Medicare Advantage plans. This is different from the initial enrollment period, which generally spans a seven-month period — three months before and after the month your client reaches age 65, as well as the month of their birthday.

Whether they elect to make changes during the annual enrollment period or keep coverage as-is, clients’ choices will be effective as of Jan. 1 of the following year.

You want to be sure that your clients are looking at their coverage each year to help ensure that they have the best coverage for them at the lowest cost. If they need professional help in choosing another plan, and if you don’t do this type of work yourself, you should refer them to a trustworthy professional who does and who has the needed expertise.

In the coming weeks, advisors should set aside time to have a discussion with clients on Medicare to help them decide if any changes in their coverage may be needed. Here are a few topics to make sure to hit.

Alternative Coverage Options

The annual enrollment period is the time to work with your client to review their health needs against their current coverage. Things they can do during the annual enrollment period include:

  • Switch from original Medicare, Parts A and B, to a Medicare Advantage plan (Part C). In order to do this, they must have first been enrolled in Parts A and B.
  • Switch from one Medicare Advantage plan to another.
  • Drop their Medicare Advantage plan and go back to original Medicare Parts A and B.
  • Switch from a Medicare Advantage plan that does not offer a drug plan to one that does, and vice versa.
  • Join a new Medicare drug plan.
  • Switch from one Medicare drug plan to another.
  • Drop Medicare drug coverage completely.
  • Add a Medigap supplement.

Deciding whether to take any of these actions should be based on planning for your client’s evolving medical needs.

Changes to Medicare Plan Costs

It is common for Medicare Advantage (Part C) and Medicare drug plans (Part D) to raise prices going into the new year. You will want to review any changes in premiums, deductibles and other cost issues with your client each year prior to the annual enrollment period.

Plans typically provide an Annual Notice of Change letter each year by September. Encourage your client to review this. You should consider looking at it as well to be in a position to answer any questions they may have, or to provide guidance in getting answers from the plan provider.

If these cost increases or any changes in plan coverage are problematic for your client, it may make sense for them to look at other Medicare options.

Changes to Plan Coverage

Medicare Advantage plans and Medicare prescription drug plans can change over time. A hospital may drop out of the plan’s network. A drug your client needs may not be part of the prescription drug plan’s formulary going forward even though it had been in the past.

It’s not uncommon for Medicare plans to change from year to year. As we head into the annual enrollment period, your client should review any changes in their plan to be sure the plan still aligns with their needs.

Changes in the Client’s Health

Your client’s health situation may have changed over the past year. This could include:

  • A new health diagnosis
  • Planned health or surgical procedures
  • New prescription medications

These and a host of other changes in your client’s health situation can be a good reason for your client to review their current Medicare coverage and consider making a change. Different plans may cover different procedures and other services in different ways. Some plans may not cover certain procedures or services to the extent that others do.

In the case of prescription medications, coverage under Part D or Medicare Advantage plans can vary. Certain prescription medications may be covered to a greater or lesser extent under certain drug plans or Medicare Advantage plans. Medicare Advantage plans have a formulary, which is a list of covered prescription drugs.

A change in your client’s health situation necessitating new medications, a certain health or surgical procedure or other services can be a good reason to look into different Medicare coverage during the annual enrollment period.

New Doctors or Other Providers

Your client may have changed doctors or added additional doctors due to a change in their health situation. The new doctor(s) or other medical professionals may not be a part of your client’s existing plan’s network. This could result in higher out-of-pocket costs for treatment.

This is something that your clients need to stay on top of over time as well. Providers included in the plan’s network can change, and these changes may be a good reason for your client to look at other Medicare plan options.

Medicare Advantage Open Enrollment

Besides the annual enrollment period for Medicare that runs from Oct. 15 to Dec. 7, there is also an open enrollment period for Medicare Advantage plans that runs from January 1 to March 31 each year.

If your client is enrolled in a Medicare Advantage plan, this is the time when they can switch to another Medicare Advantage plan, or switch to original Medicare and join a separate Medicare prescription drug plan. They are limited to one switch during this time period.

If this is something your client is considering, it is important that they compare their total coverage under both options to see which option is the better deal for them. There may also be a time limit for them to enroll in a Medigap plan without being subject to a medical exam requirement.

If your client switches from a Medicare Advantage plan to original Medicare, they will generally want to enroll in a Medicare Part D prescription drug plan. They will also want to enroll in a Part D plan if they didn’t do so when they were first eligible to enroll in Medicare. Failure to enroll in an approved drug plan when first eligible can result in permanent penalties if your client did not have other creditable coverage.

Roger Wohlner is a financial writer with over 20 years of industry experience as a financial advisor.


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