Medicare Annual Open Enrollment: What You Need to Know

Michael Braun, Franklin Benefits Group LLC

 

Medicare Annual Open Enrollment is drawing near and in late September you should receive your Annual Notice of Change, a document you should study carefully. It lists any updates coming to your health plan next year, including changes to its physician network as well as changes in drug coverage.

According to a report by the Kaiser Family Foundation, just three in 10 Medicare beneficiaries review their coverage during this period, which runs annually from Oct. 15 to Dec. 7.

While it’s tempting to just let your plan auto-renew for next year, it could end up biting you if you have, for example, a Medicare Advantage plan that drops your personal physician or your preferred medical facility from its network.

And it’s especially important to review your coverage during the 2025 open enrollment due to the substantial changes coming to Medicare.

During open enrollment you may do the following:

• Switch from Original Medicare to a Medicare Advantage plan, or vice versa.
• Change from one MA plan to a different MA plan.
• Change from an MA plan without drug coverage to an MA plan with drug coverage, or vice versa.
• Enroll in a Medicare prescription drug plan (if you didn’t do this when you first became eligible for Medicare, you may be hit with a late enrollment penalty every year going forward).
• Switch from one Medicare drug plan to a different Medicare drug plan.
• Quit your Medicare prescription drug coverage.
• Apply for Medicare supplement insurance (Medigap) if you are on Original Medicare currently, or if you want to return to it from MA. However, if you are enrolling in a Medigap policy for the first time, you may pay more than expected and you could be denied coverage.

Pay special attention this year

MA plans can change year to year, from the doctors who are in-network to the cost of your prescription drugs, so it’s a good idea to do some comparisons to make sure you’re still in the right plan for you.

Also, there are likely to be substantial changes to Part D plans (and MA plans that include Part D), thanks to new regulations that are changing how drugs are covered. Starting in 2025, Part D enrollees have to pay $2,000 out of pocket for covered medications before the “catastrophic coverage” phase kicks in. At that point, they will have no copays or coinsurance for their covered medications.

These changes will force Part D insurers to make changes to the list of medications they will cover, as well as their premiums. This is why it’s vitally important that you review your Annual Notice of Change.

What you can do now

You can get a jump start on open enrollment by marking the following in your planner:

Late September — Watch for your Annual Notice of Change in the mail in late September, and be sure to study it carefully.

Mid-October — Annual Open Enrollment starts Oct. 15. Use the Medicare Plan Finder to identify any changes in your plan’s coverage, restrictions and costs. Then, compare that to other plans that are available.

By end-November — At this point you should have found a new plan or decided to stay in your current plan. If you swap plans, you’ll be unenrolled from your current plan automatically. Yes, open enrollment ends Dec. 7, but if you wait until the last minute to make changes, the possibility of having complications grows.

Please contact Franklin Benefits Group LLC to schedule a consultation.