Open enrollment for Medicare health and drug plans begins on Oct. 15.
Every year between Oct.15 and Dec. 7, Medicare recipients must decide if their current coverage will continue to meet their needs through the upcoming year. Changes must be made by Dec. 7, 2023, to be effective in 2024.
When enrolling in Medicare or making a change to your plan, there are several options available.
Medicare Advantage Plans are another way to get Medicare Part A and B coverage. Medicare Advantage Plans, sometimes called Part C or MA Plans, are offered by Medicare-approved private companies that must follow the rules set by Medicare. If you sign up for the Medicare Advantage Plan, you’ll still have Medicare, but you will get most of your Part A and Part B coverage from your Medicare Advantage Plan, not Original Medicare.
With Original Medicare, patients can go to any provider or healthcare facility in the US that accepts Medicare. With Medicare Advantage, however, you must use only the doctors and providers in the plan’s network and service area.
TCMH is in-network with the following Medicare Advantage Plans: Anthem Blue Cross Blue Shield, AETNA, United Healthcare, and WellCare. If a person has a PPO (Preferred Provider Organizations)-type Medicare Advantage plan with another carrier, most can be seen at TCMH, but in most cases, they will have to pay an out-of-network rate. Some plans, like HMOs (Health Maintenance Organizations), are even more restrictive, where patients would not be covered if they went out of network.
During 2023, the out-of-pocket limit for Medicare Advantage may not exceed $8,300 for in-network services and $12,450 for in-network and out-of-network services combined. In 2024, these limits will increase to $9,450 and $18,900.
However, there is no limit on out-of-pocket expenses with Original Medicare if you do not have a Medigap Plan or Medicare Advantage (or retiree plan).
A benefit of the Medicare Advantage Plan is that you may have coverage for things Original Medicare doesn’t cover, like fitness programs and some vision, hearing, and dental services.
A drawback of the Medicare Advantage Plan, in general, is that they don’t offer the same level of choice as a Medicare plus Medigap combination. Most plans require you to go to their network of health providers.
Since Medicare Advantage Plans can’t select their customers, meaning they must accept any Medicare-eligible participant, they discourage people who are sick by the way they structure their copays and deductibles. Many enrollees have been hit with unexpected costs and denial of benefits for various care deemed not medically necessary.
Out-of-pocket costs can quickly increase over the year if you get sick. The Medicare Advantage Plan may offer a $0 premium, but the out-of-pocket surprises may not be worth those initial savings if you get sick.
You can join, switch, or drop a Medicare health plan or a Medicare Advantage Plan (Part C) with or without drug coverage during various times. The first opportunity is during the initial enrollment period; you can join a plan when you first become eligible for Medicare. The second opportunity is during the open enrollment period between Oct. 15 and Dec. 7 each year; you can join, switch, or drop a plan. Your coverage will begin on Jan. 1 if the program has your request by Dec. 7. And finally, the last opportunity is during the Medicare Advantage Open Enrollment Period between Jan. 1 and Mar. 31 each year. If you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare once during this time. However, you can only change plans once during this period.
Ozark Action, a partner of the Missouri State Health Insurance Assistance Program (SHIP), will be available at TCMH to provide information about Medicare and Medicare Advantage Plans on Tuesday, Sept. 19, from 9 a.m. to 3 p.m. in the hospital’s main lobby. SHIP is certified by the federal and state governments to provide free, unbiased, and confidential Medicare counseling and education to help individuals navigate the open enrollment process.