Medicare Annual Enrollment Period opening

Tomorrow, Oct. 15, marks the beginning of Medicare’s “Annual Enrollment Period” (AEP). This is the one time of the year when people on Medicare are able to change their Medicare Advantage HMO plans or their Medicare Part D Prescription Drug Plans (PDP).

Most people on Medicare should be reviewing not only their current coverage, but also the other plans available. This is what my office does, and wow are we finding issues that would have been overlooked by the client.

Envision a PDP plan has been sold. To continue with their low-cost PDP plan requires a new enrollment in the new company’s plan. If ignored, the coverage will “roll over” to a plan that is about three times the monthly cost.

The public has access to the “Outline of Coverage” for all plans available, and I encourage you to look at not only your current plan, but the others as well. You will learn that your doctor and medical group are on many plans. You might also find out your favorite local pharmacy that was “preferred” last year is “standard” for 2021 and the copays of your prescriptions may have jumped.

While the law forbids me to accept applications until the 15th, I have been reviewing and making recommendations since the 2021 data became available Oct. 1. Of the most remarkable, one lady had major changes, as two of her very expensive medications will be covered next year but they will be at Tier 4 rather than the current Tier 3. On her plan, Tier 3 has a fixed-dollar copay of $47 per refill. Tier 4 has a coinsurance cost of 33%. 33% of $850 (the retail price) will be an out-of-pocket cost of $285.50 a month. From an affordable $47 to $285.50 is a great leap in cost. The company discloses that there is a tier change, but what does that mean to the senior who just carries on year to year shelling out more money?

Another issue I am uncovering is that most of the HMO plans have increased their benefits for the coming year. The “con” is that the hospital copay may have dropped, but the inexperienced shopper isn’t aware that another company using the same doctors has a $0 copay for hospitalization and a better prescription plan. Some HMOs are better than others.

What really frosts me is those “advisors” that come from insurance companies. They talk with glowing accolades of how wonderful their plans are, but they don’t have access to their competitors’ plans.

It’s like going to a Ford dealership for a pickup: I can assure you that you will drive off the lot in a Ford, even though a better deal might be from Chevrolet. An insurance specialist like myself works with all the companies. I get paid by the insurance company and Federal law regulates the commissions, so it is the same commission no matter what company you ultimately get.

This past week I had to console a woman who enrolled with a plan from an online internet ad. The salesman neglected to ask her what prescription drugs she took. When I researched her needs I found a plan perfect. It used her current doctors, but I figured the agent only had a few plans to offer her. Insurance agents need to be licensed in the state you live in as well as appointed with the local plan. Most of the web-based agents get licensed for the states they do business in. They typically get appointed with only a few of the national brands. If a local brand has better benefits for the client and they are not appointed, it is passed over because they won’t get paid.

I differ. Being local, I am appointed with all the plans that use insurance agents. Every so often the best plan for the client does not use agents. I will assist in that enrollment without pay. Being local, I know that by providing the best service, what I might lose in one sale will come back in referrals.

With the AEP just beginning, keep in mind that this is not like income taxes.

There are no extensions. If you don’t act early, you may be stuck in a plan that is not your best fit. Call my office today and request a “white card” for a free no-obligation review.

Click here to add a comment

Leave a comment: