Aging Options

Medicare Open Enrollment is Here – and Experts Say These are the Eight Decisions You Need to Make

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Like a window that opens for a time and then closes, that familiar period known as Medicare Open Enrollment has come around again. Since it started last week, on October 15th, the Open Enrollment clock has started ticking, and will keep on doing so until the window closes on December 7th.

During these seven-plus weeks, beneficiaries can evaluate their current medical and prescription drug coverage and make changes that better suit their changing needs. Once the period is over, though, many of those changes become difficult or impossible to implement, so these are crucial weeks for seniors.

Large Number of Seniors Skip Open Enrollment

Yet despite what’s at stake, it turns out that a huge percentage – 71 percent, current research shows – of seniors make the error of ignoring Open Enrollment entirely.  There are probably plenty of reasons. Some might find it confusing to evaluate complicated choices, or they’re reasonably satisfied with the plan they have. But by ignoring Open Enrollment, these complacent seniors could be putting their health and their budget at serious risk.

(If you want to read the definitive background on Open Enrollment, this article from the Center for Medicare and Medicaid Services provides a good tutorial. We should also note that there is an additional Open Enrollment period in the first quarter of 2022 for those already enrolled in Medicare Advantage. Here’s the explanation, also from CMS.)

We generally like the Motley Fool website for its practical, no-nonsense approach, and that’s what drew us to this recent article about Open Enrollment in 2021. The article lists eight specific things that Medicare beneficiaries need to consider. We’ve re-cast them as eight critical decisions most seniors need to make during the coming weeks. We invite you to check out this list and see which decisions apply to you. Let’s take a look.

Decision #1: Decide How Changes to Your Advantage Plan Affect You

If you’re on a Medicare Advantage plan, says Motley Fool, you have likely already received a notice alerting you to any plan changes for the coming year. “Review those details carefully,” the article warns, “because if your plan is shifting in a way that hurts you, you’ll want an opportunity to find a new one.”

We know from personal experience that it’s easy to ignore the thick Medicare Advantage plan booklet when it comes in the mail. But the only way to see how your plan is changing is to read it carefully. This is one of those times when what you don’t know can hurt you.

Decision #2: Decide How Changes to Your Part D Plan Affect You

“Just as Medicare Advantage plans are required to inform enrollees of changes,” writes Motley Fool, “so too are Part D drug plans. Be sure to review your notice of change to see if your plan will no longer be good for you.”

You may find that a drug you take has moved from one category to another, for example, possibly driving your costs up dramatically. Some specialty drugs might have been dropped altogether. Don’t wait until it’s too late or you could learn a costly lesson.

Decision #3: Decide if Another Advantage Plan is Better for You

“Even if your Advantage plan isn’t changing in a negative way, there could still be a better plan out there for you,” the Motley Fool article advises. “It pays to see what options are available and whether there’s an opportunity to reap some savings in the process.”

This is especially true these days as Medicare Advantage firms keep adding a broader array of services to their policies. Other plans might offer benefits that appeal to you. Remember, too, that you want to make certain the doctors you see under your plan this year will still be available next year.

Decision #4: Decide if Your Prescription Needs Have Changes

“Your Part D drug plan may not be changing much going into 2022 – but your specific needs might,” says the article. “Review the medications you’re taking right now and expect to continue taking into the new year. It could be that based on changes to your prescriptions, there’s a better Part D plan out there for you.”

Decision #5: Decide if There’s a Better Part D Plan

There are two critical components to prescription drug coverage: your needs, and the terms of the plan you’re considering. Even if your Part D plan may not be changing for 2022, says the Motley Fool article, and even if your medications may be staying the same, “it’s still worth reviewing your plan options and seeing if there’s a less costly drug plan you can sign up for.” The savings can be substantial.

Remember that the plan with the lowest premium may not be the best for you. Co-pays, deductibles, and out-of-pocket maximums can all vary widely. It pays to do your homework.

Decision #6: Decide if You’re Done with Original Medicare

Original Medicare serves the needs of millions; yet, as the article reminds us, there are key health services, like dental care, hearing aids, and eye exams, that basic Medicare does not cover.

“If you’re tired of those expenses eating away at your Social Security income,” says Motley Fool, “then you may want to look at moving off of original Medicare and signing up for an Advantage plan instead.” The other option is a supplemental plan nicknamed a Medigap policy, purchased at extra cost from a carefully regulated private carrier. A Medigap policy can offer an advisable way to control added costs. It might be worth consulting an expert for an apples-to-apples comparison to evaluate which option is best: Medicare Advantage or Medicare with a Medicap policy.

Decision #7: Decide if Original Medicare is the Better Way to Go

“While Medicare Advantage commonly covers more services than original Medicare, it can also be more limiting with regard to in-network providers,” the Motley Fool advises. “If you’re unhappy with your Advantage plan and aren’t seeing a great replacement option, it may be time to switch over to original Medicare.” One caution: we would add that a stand-alone Medicare policy can leave you dangerously exposed to high out-of-pocket costs, which you’ll need a Medigap policy to cover.

Be forewarned, however, that you might not be able to buy a Medigap, or Medicare Supplement, policy after having been on a Medicare Advantage, without going through a health screening. When beneficiaries first become eligible for coverage, companies are required to offer Medicare Supplement policies regardless of preexisting health conditions. But those seeking to return to original Medicare may find themselves disqualified from buying a Medigap plan based on poor health. You can be turned down or charged a higher premium.

Decision #8: Don’t Wait – Get Started Early!

“Though Medicare open enrollment is seven weeks long, reviewing your coverage choices can be a time-consuming process,” says the article. “Do yourself a favor and start the process early. If you wait until late November or early December, you might run into a real crunch. The more strategic you are during open enrollment, the more likely you’ll be to end up satisfied with your health coverage for 2022.”  We agree completely.

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(originally reported at

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