No, not Halloween! Medicare Open Enrollment!
By now, annual Medicare Open Enrollment has been going on for a few weeks. The fact that it concludes December 7th is no comfort for how annoyed we will be by the relentless ads that will fill the airwaves week after week until then.
Last year, we posted some information about Medicare Open Enrollment, which I have edited to present again this week. In case you still want to change your plan, you have time to do it, but there are some issues to think about.
How do you know if a new plan would be better for you? And what would “better” mean? Are all your prescription drugs covered on your Part D Plan this year? (Hint: some are not, like Levothyroxine). One way to find out if another plan would be better, in terms of costs at least, is to go to the Medicare.gov website. If you have an account already, you just log in. If you have not established an account, they make it easy for you to get one, but you don’t need an account to compare plans.. On the Medicare site you can compare health or drug plans to the ones you have in terms of premium costs, annual costs, size of the network, and coverage. Since basic Medicare services are pretty much the same across all health plans, the biggest difference among health plans is likely to be cost, the extent of the provider networks, and the extra “perks” offered as part of Part C or Medicare Advantage plans — like discounts for vision and dental exams or gyms. If you have original Medicare plus a Medigap/supplemental plan, you will need a prescription drug plan (Part D). Part D plans are not all alike in terms of what drugs they cover and they do change from year to year. Your prescriptions may not be included in 2025, so you may need to shop around on the Medicare website for a drug plan. It’s a worthwhile use of your time.
The good news about drug coverage is that there will be a LIMIT on your out of pocket costs for drugs in 2025 for the very first time ever. No Medicare beneficiary will pay more than $2000 a year out of pocket for their prescription drugs. For those of you who take very few drugs, this might not seem like a big deal. But some of the newer drugs and cancer drugs can reach the $2000 level quickly. In 2023, as part of Biden’s Inflation Reduction Act, the price of insulin was capped at $35 a month for Medicare beneficiaries. Older diabetics saved a lot in 2024 and will continue to save in 2025. And by 2026, the price of 10 expensive drugs like Eliquis and Xarelto (the ones you see ads about) will be able to be negotiated by Medicare, something Medicare has not been allowed to do in the past.
Just to remind you — when you turned 65 and were eligible for Medicare, you had three basic choices for your medical care (Part D is a separate program for prescription drugs): 1) Stay with what is called “Original Medicare” (Parts A and B and choose a prescription drug plan, Part D separately), which will cover about 80% of your costs; 2) Enroll in original Medicare plus a Supplemental (“MediGap”) Plan to fill in most of the other 20%; or 3) Enroll in Part C, the HMO/PPO Medicare Advantage plan which covers Parts A, B and D. In Part C, the government pays the health plan a lump sum to take care of you. If you do well and don’t need many services, the insurer will make a profit which by law Medicare mandates to be partly shared with you, the member. However, if you use a lot of services, the insurer may lose money. It should be to the benefit of the health plan to keep you healthy and provide you with as much preventive and maintenance care as possible. At least, that’s the theory. Many Medicare Advantage plans actually have attractive features like zero monthly premiums and extra services. There are two periods in which you can change from one Medicare Advantage plan to another — the October 15-December 7 period and the January 1-March 31 period.
Before you choose a Part C Medicare Advantage plan, or leave your Medigap/supplemental arrangement, be pretty sure you want to stay with that plan for a long time. Changing back to original Medicare plus a MediGap plan after the first year of being in Medicare Advantage may cause you to have your pre-existing conditions considered in the pricing. This practice is called “underwriting,” allowing the insurance company to price your premium in relation to your health status. There are some complicated rules about when you can enroll, disenroll, and switch choices. Use the Medicare website to provide you accurate information about changing options or call the Center for Health Care Rights or the HICAP program in your area. These are nonprofits that can give you independent information. They don’t sell insurance and they are happy to answer even the most basic questions.
If you choose original Medicare with a MediGap/supplemental plan, most people choose one of the A-N plans. The differences among these plans are NOT so much which services are covered. (There are a few differences you can see in this great comparison chart from the Medicare.Gov website.) The main services supplemental plans cover are standardized across all plans. The differences will be how much you will pay for any of these services if you need them. It’s easy to see that the more of the costs that are covered, the higher your monthly premiums will be, so Plans K and L, which only cover 50% or 75% of some of these costs might seem too skimpy. Yet, Plans K and L are still the ONLY Supplemental plans that have a limit on your annual Out of Pocket costs and the monthly premiums are lower too. The other plans may seem to cover 100%, but if the charge is disallowed by Medicare or not considered “medically necessary,” you can be left with some significant out of pocket costs. Plan options K and L guarantee that after you have paid your Part B Deductible and reached these annual out of pocket limits in 2025 ($7220 for Plan K and $3610 for Plan L), the plan will cover 100% of any remaining costs.
Bottom line – it’s important every year to check and be sure your favorite doctors and hospitals are still in your health plan and that your prescription drugs will be covered in the same way next year. The only way to find out is to do your due diligence and check the Medicare website. I just changed my drug plan and reduced my monthly premium from $53 to $1.80!!