5 things to check during Medicare open enrollment

Oct 31, 2023 02:35PM ● By National Council on Aging

Medicare’s Open Enrollment Period starts October 15 and goes through December 7 every year. Since Medicare plans change each year, it’s a good idea to make sure your coverage still meets your needs. And unless you qualify for a Special Enrollment Period, this is the only time you can join or switch health (Medicare Advantage) and prescription drug (Part D) plans for the coming year.

If you or a loved one has been affected by a recent natural disaster, your open enrollment may extend to December 31. If you want to request an extended enrollment period, call 1-800-MEDICARE or contact your health insurance company or drug plan directly.

In the meantime, here are five things you should check right now during Medicare Open Enrollment to evaluate whether the plan you’re in or the plan you’re looking to join is the right one for you.

1. Check your mailbox.

You may have tried ignoring the marketing mail from plans in your area, but make sure you don’t overlook anything that comes from Medicare or Social Security.

For example, if your plan decided not to renew its contract with Medicare or continue to serve your area, you should receive a notice in October and will get another reminder in November to select a new option.

If you’re receiving Extra Help to pay for your prescriptions, you may receive information about your continued eligibility for this benefit, changes in copayments at the pharmacy or a notice about selecting a new plan if your plan is being terminated at the end of the year.

If you’re currently enrolled in a Medicare Advantage or Part D plan, you should’ve received an Annual Notice of Change (ANOC) from your plan in September. Be sure to read the ANOC closely, as it outlines any changes to your costs and coverage in the coming year.

2. Check with your doctors and specialists.
Medicare Advantage plans may limit members to using specific providers. If you want to continue seeing your doctor and any specialists, check that they are still in your Medicare plan’s network. Medicare Advantage plans are required by the Centers for Medicare & Medicaid Services (CMS) to keep their online provider directories updated. People with Original Medicare usually only need to ensure their providers are still accepting Medicare assignment.

3. Check the drug formulary.
Each Medicare plan that covers prescription drugs has its own formulary, or list of covered medications. In addition, most formularies have tiers that affect how much you pay for your drugs at the pharmacy. Medicare Open Enrollment is the time to check:

• Whether the prescriptions you take are on the plan’s formulary

• What tier they fall under (and therefore what your copayment is)

• Whether the plan places any restrictions on how you can get your medication, such as quantity limits or prior authorization from your provider

4. Check with your pharmacy.
Some plans have negotiated with specific pharmacies to offer discounts to plan members who fill their prescriptions there. If you have a preferred pharmacy, or like to receive your medications by mail, be sure to compare how much you’ll pay for those options when shopping for plans.

5. Check how much Medicare will cost you in 2024.
While CMS has indicated that on average, Medicare health and drug plan premiums will increase slightly in 2024, you should look beyond premiums to determine actual out-of-pocket costs. Be sure to check for the deductible, copayments and whether you may fall into the Part D coverage gap (or “donut hole”).

How to get started when choosing your Medicare plan during Open Enrollment

If you’re confused about Medicare and need a place to start learning about your coverage options, you can compare plans by:

• Using the Medicare Plan Finder online at: medicare.gov/plancompare

• Calling 1-800-MEDICARE

• Speaking to a licensed Medicare enrollment specialist or contacting your local State Health Insurance Assistance Program (SHIP), which is federally funded to provide free, objective assistance to people with Medicare and their families.

For free help, call SHIP: