Dear Addy: Medicare Enrollment 2024

Dear Addy,

I’ve been enrolled in Medicare for a couple of years now and am weighing my plan options for 2024. What do I need to know about choosing a plan for the coming year?

Signed,

Medicare Beneficiary

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Dear Beneficiary,

Every year Medicare Open Enrollment runs from October 15 through December 7. This is the time of year when you can most easily change your Medicare Advantage or Part D drug plan, or switch from Original Medicare to a Medicare Advantage plan (or vice versa). Even if you ultimately decide to stay with the Medicare plan you are currently on, it’s a good idea to review your current coverage to make sure your plan will still meet your needs for the next year.

Refresher: Pathways to Medicare Coverage

Medicare is a U.S. government health insurance program for individuals 65 years or older, and for individuals with a qualifying disability. Original Medicare includes hospital insurance (Part A) and medical insurance (Part B). Enrollees in Original Medicare  can and should also add prescription drug coverage (Part D) and supplemental coverage to pay for deductibles and coinsurance for Part A and B covered services. Potential sources of supplemental coverage include Medicaid, for eligible low-income beneficiaries; a retiree plan sponsored by an employer or union; or a “Medigap” plan issued by a private insurer. Supplemental coverage is essential for people with bleeding disorders who enroll in Original Medicare. Infused and injected bleeding disorder medications are covered under Medicare Part B (rather than under Medicare’s Part D drug benefit) – and Medicare Part B benefits are subject to uncapped 20% coinsurance. Supplemental coverage protects enrollees against that potentially catastrophic financial exposure.

As an alternative to original Medicare, some people choose to purchase an “all-in-one” privately issued Medicare Advantage plan that covers all their hospital and medical services (Part A and Part B). Most Medicare Advantage plans also offer prescription drug coverage (Part D), and many offer additional benefits such as dental, vision, or hearing. Under Medicare Advantage, enrollees must get their care from doctors and hospitals within their plans’ defined networks – so it is important for Medicare Advantage enrollees to check that their key providers remain in-network. By law, a Medicare Advantage enrollee cannot purchase a Medigap supplemental plan.

Considerations for Open Enrollment

If you currently are on a Medicare Advantage plan, you should review your provider’s Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) to ensure that your plan will still meet your needs for the following year.

If your existing plan no longer best serves your needs, you can change your coverage during the October 15 – December 7 open enrollment period. Your changes will take effect on Jan. 1, 2024. If you do not pick a new plan, you will be automatically renewed in your current coverage.

Medicare beneficiaries who are considering switching from Original Medicare to a Medicare Advantage plan should be aware that it may be difficult ever to undo that choice. That’s because most states allow Medigap policy issuers to reject applicants with health conditions, charge them more, or limit coverage for their pre-existing conditions, for anyone who seeks to buy a Medigap plan outside their initial window of eligibility for Medicare.

Those with traditional Medicare who purchased a Part D plan to cover their prescription drugs (remember, Part D does not cover injectable bleeding disorders products) may want to review their existing plan to ensure it continues to offer the best coverage. This is especially true if you have changed medicines in the past year. Further, health plans at times transfer drugs to different coverage levels from year to year, so do not assume your current coverage will be the same going forward. You can learn more about your Medicare options at www.Medicare.gov and get free, impartial advice from your State Health Insurance Assistance Program (SHIP). You can also check out this “Medicare 101” video on HFA’s YouTube channel.