The Medicare Annual Enrollment Period (AEP) is coming up soon—October 15 through December 7. This is your yearly opportunity to review your Medicare coverage and make changes to your plans. Are you ready?
Whether you’re reevaluating if Original Medicare or a Medicare Advantage Plan is the right coverage for you, looking for a Medicare Advantage Plan that includes more benefits, or want to save on the costs of your Part D prescription drug coverage, being prepared is key.
Let’s look at five steps you can take before AEP begins that can help you make informed decisions for the best plans and coverage to meet your healthcare needs.
1. Gather Your Medical Records
Your medical records provide a comprehensive picture of your healthcare needs, with the details of your health history and current medications, treatments, diagnoses, and conditions. Looking at your medical records for the last year can help you assess if your current plan is adequately covering these healthcare needs and their costs.
Start by collecting the following from the past year:
Doctor Visit Notes
Look at doctor summaries from this year’s check-ups and specialist appointments. Are there any new diagnoses, treatment recommendations, or changes to your care plan that could affect your coverage costs?
Prescription Medications
Make a list of all the current prescription medications you’re taking. Include dosage, frequency, and what “tier” these prescriptions are in within your current Part D plan. Did you start any new medications this year or see any tier changes or price increases on existing medications?
Insurance Statements
These are the quarterly Medicare Summary Notice from Medicare or the Explanation of Benefits statements from your Medicare Advantage Plan and/or Medicare Part D plan. These statements give you a summary of what healthcare providers have billed Medicare or your Medicare Advantage Plan, what was paid, and what you may owe. This will give a picture of how much of the healthcare costs your current plans are covering.
Medical Bills
These reflect what you owe healthcare providers for the services and treatments you’ve received. This will help you know exactly what your out-of-pocket costs have been for the past year with your current plans.
2. Review Your Current Plan Details
After completing your initial Medicare enrollment and plan selections, it can be easy to get into “autopilot” mode with your plans, especially if you’re satisfied with your coverage. Unfortunately, plans change—often every year. What worked for you last year may not be the best option now. This is why you want to thoroughly review your current Medicare plan details before AEP begins.
Know Your Plan’s Coverage
This is a good time to revisit your plan’s documents (like the Summary of Benefits and Evidence of Coverage) to review what your plan covers and what you’re responsible for. Refamiliarize yourself with these elements of your plans:
- Premiums: How much you’re paying each month for your plans.
- Deductibles: The amount you have to meet and pay out-of-pocket before your plans fully pay.
- Co-payments and co-insurance: What you’re responsible for paying when you visit a healthcare provider or fill a prescription.
- Network restrictions: Privately insured Medicare Advantage and Medicare Part D plans often have a set network of providers, with “out-of-network” providers costing more. Know which doctors, hospitals, and pharmacies are in-network.
Identify Any Gaps in Coverage
Compare your plan’s coverage with your medical records, particularly your insurance statements and medical bills. Based on what your plan covers and what you’re paying, are you seeing any gaps in coverage or surprise costs? If you’ve started seeing a different doctor or you’ve been referred to a specialist, are they in-network? What prescription “tier” are your current medications covered at? Or, if you’ve started a new medication, does your plan cover it? Identifying these gaps will help you determine if you need to switch plans during AEP.
Be Aware of Any Plan Changes
Is your plan provider making any changes for the upcoming year? Or have you already seen changes, like the price of a prescription going up? Providers often update their coverage, networks, and costs annually. If this is the case, you should have received a notice. Be sure to keep any notification of coverage changes with your plan documents. Understanding these changes before you enter AEP can help you avoid surprises and make an informed decision about whether to stick with your current plan or explore other options.
3. Consider Upcoming Life Changes
Healthcare plans aren’t the only things that change. Sometimes, it’s your life circumstances that change, and your healthcare plan needs to change with them. That’s why it’s essential to factor in any recent or upcoming life changes when preparing for AEP.
Below are common life changes that can affect your healthcare coverage needs. Keep in mind that some of these may qualify you for a Special Enrollment Period (SEP) based on the qualifying event date, giving you an additional period outside of AEP to make plan changes.
Retirement
If you recently retired or are planning to retire in the upcoming year, know that retirement will affect your healthcare coverage, costs, and plan options. If your employer provides retiree health insurance, be sure you understand how Medicare works with this other healthcare coverage. Many retiree health plans are in fact Medicare Advantage Plans and subject to the same Medicare enrollment periods, so know the type of plan you have before AEP begins.
Family Changes
If your spouse retires, passes away, or your marital status changes, your financial situation and healthcare coverage can also change. This can be especially true if you’re a stay-at-home spouse whose healthcare coverage can be impacted by the Medicare eligibility and retirement date of a working spouse. Assess any changes in your family, finances, or coverage needs to ensure you still have the best plan for you.
Relocation
While Original Medicare covers any healthcare provider within the U.S. who accepts Medicare, the in-network providers of Medicare Advantage Plans are often location based, down to the zip code. If you’re planning to move, double check that your current plan’s network of providers and pharmacies are still available where you’re going. If not, consider changing to a plan with a larger network in your new location.
Health Changes
If you’ve been diagnosed with a new condition, prescribed new medications, or anticipate needing surgery or specialized care in the coming year, be sure your current plan is covering these needs. This is another good reason to review your medical records and plan details. Based on these documents and changes to your health, you may want to compare plans for the broadest coverage at the lowest costs.
4. Get Personalized Guidance for AEP
Reviewing your medical records and plan documents, assessing your current and changing health needs, and making coverage decisions during AEP can feel overwhelming. A Medicare Advisor can serve as your personal guide through the Annual Enrollment Period.
These licensed Medicare agents provide you with:
Knowledgeable Expertise
Medicare Advisors are professionals with years of experience. They know every Medicare plan available within their geographic area, what is covered, and the true costs of every plan. They’ll walk you through all these available plan options and their details.
Personalized Guidance
Medicare Advisors don’t just know Medicare plans; they get to know people. Your Medicare Advisor won’t merely help you to understand the different plan details and coverage options. They’ll work to understand you—your changing health, financial, and lifestyle needs to ensure you have a plan that best meets these needs, for the best price.
Informed Choices
A Medicare Advisor isn’t here to sell you a plan; they’re focused on helping you choose the right plan. That means providing you with relevant information and guiding you through all that information, so you’re empowered to make an informed choice with confidence and peace of mind.
5. Schedule a Free Consultation with Wandacare
Wandacare is your trusted Medicare Advisor in Lakeland and greater Polk County. With over a decade of experience, our licensed Florida agents are ready to guide you through this year’s Medicare Annual Enrollment Period. We’ll thoroughly explain the available plans and compare them with your current coverage, healthcare needs, and budget to ensure you have the best plan for the coming year.
You don’t have to complete AEP alone. Schedule your free consultation with Wandacare today!
