Quick Answer: What to Check Before Dec 7
Quick answer: Before the Open Enrollment deadline on Dec 7, check whether your parent's Medicare plan still covers their doctors, drugs and budget. This includes checking for changes in premiums, co-pays, deductibles, provider networks, and prescription drug benefits. If you're unsure about any changes or need help comparing plans, reach out to your plan's customer service or your local State Health Insurance Assistance Program (SHIP) for free, unbiased assistance. Medicare Plan Finder and State Health Insurance Assistance Program let you compare plans side by side.
Review the Annual Notice of Change (ANOC) for any updates to costs and coverage.
Check if your parent's preferred doctors and specialists are still in the plan's network.
Check the plan's drug formulary for every medication your parent takes.
Compare the plan's costs, including premiums, deductibles, and co-pays, against your parent's budget.
Look into any changes to provider networks, pharmacies, and extra benefits offered by the plan.
Reviewing the Annual Notice of Change (ANOC)
The Annual Notice of Change (ANOC) is a letter you receive from your Medicare Advantage or Part D prescription drug provider every September. It outlines any changes to your health care costs and coverage for the following year, such as shifts in premiums, co-pays, provider networks, or prescription drug benefits. Reviewing the ANOC helps you determine if your current plan will still meet your health and financial needs starting January 1. Learn more about the ANOC.
Monthly premium
Maximum out-of-pocket limit
Doctor and specialist copays
Hospital costs
Prescription drug coverage
Provider and pharmacy network
Medical benefits
Extra benefits
Comparing Medicare Plans
Comparing your parent's current Medicare plan with other options available during Open Enrollment shows whether another plan would cover them better for less. Here's a step-by-step guide to help you through the process:
Review the Annual Notice of Change (ANOC) from your parent's current Medicare plan provider. This document outlines any changes to costs, benefits, covered medications, provider networks, pharmacies, and coverage rules for the coming year. Annual Notice of Change
Check with your parent's doctors and specialists and confirm they are still in the plan's network. Medicare Advantage plans may limit members to using specific providers.
Review the drug formulary of the current and potential new plans. Each plan has its own list of covered medications, and most have tiers that affect drug costs.
Compare the costs of the current plan with other options. Look beyond premiums to check for deductibles, copayments, and out-of-pocket limits.
Use the Medicare Plan Finder to compare coverage, estimated drug and health care costs, provider networks, pharmacies, benefits, and quality ratings. Medicare Plan Finder
If you need help, contact your local State Health Insurance Assistance Program (SHIP) for free, unbiased help. State Health Insurance Assistance Program
Understanding Plan Costs and Benefits
Understanding the costs and benefits of different Medicare plans tells you what your parent will actually pay next year. Medicare Advantage and Part D plans can change their premiums, copays, deductibles, provider networks, and benefits each year. These changes can significantly impact both the affordability and accessibility of your healthcare. For instance, a higher premium or increased copays could affect your budget, while changes in provider networks might limit your access to preferred doctors and pharmacies.
Review the Annual Notice of Change (ANOC) to understand any upcoming changes to your plan's costs and benefits.
Compare different plans using the Medicare Plan Finder to find one that best fits your health needs and budget.
Consider not only the monthly premiums but also the out-of-pocket costs, including deductibles, copays, and coinsurance.
Check if your preferred doctors, specialists, and pharmacies are included in the plan's network.
Look into any extra benefits offered by Medicare Advantage plans, such as dental, vision, and hearing coverage, which can provide additional value.
Checking Provider Networks and Pharmacies
When reviewing your parent's Medicare plan, verify that their preferred doctors, specialists, and pharmacies are included in the plan's network. That way they can keep seeing the providers they trust without unexpected out-of-pocket costs. To do this, check the plan's provider directory, which should be updated and available online. If your parent is enrolled in a Medicare Advantage plan, confirm that their current doctors are still in-network, as these plans may limit members to specific providers. For those with original Medicare, confirm their providers still accept Medicare assignment. Additionally, verify that their preferred pharmacy is part of the plan's network to avoid higher costs for prescriptions. Use the Medicare Plan Finder to compare plans and their networks.
Common Questions
What if my doctor is no longer in my plan's network? If your doctor is no longer in your plan's network, you may need to switch plans or find a new doctor within your plan's network. Check the Medicare Plan Finder to see if there are other plans that include your doctor. Medicare Plan Finder
How do I know if my prescriptions are covered under my new plan? Look up each prescription in your new plan's drug formulary. You can find the formulary on the insurer’s website or use the Medicare Plan Finder. Medicare Plan Finder
What if I need extra benefits like dental or vision coverage? Medicare Advantage plans often offer extra benefits such as dental, vision, and hearing services. Check the plan details to see if these benefits are included. If not, you may need to choose a different plan that offers the extra benefits you need. Medicare Advantage
Can I switch plans if I'm not satisfied with my current one? Yes, you can switch plans during the Medicare Open Enrollment Period from October 15 to December 7. Review your options and choose a plan that better meets your needs. Medicare Open Enrollment FAQ
Bottom line: Take the time to review your Medicare plan options during the Open Enrollment Period. Compare costs, benefits, and provider networks and pick the plan that fits your health and financial needs. If you need help, contact your local State Health Insurance Assistance Program (SHIP) for free, unbiased assistance. State Health Insurance Assistance Program
Related reading: Understanding Grief and Anticipatory Loss as a Caregiver and Medication Safety at Home for Older Adults: A Caregiver System.
This article is general information, not legal or financial advice. Rules and eligibility change, so confirm details with the program or a qualified advisor before making decisions.
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