Navigating Annual Enrollment Period Successfully

With the Medicare Annual Enrollment period now here you have likely noticed those more changes within your Annual Notice of Change (ANOC) letter.  A carrier may have eliminated your plan.  Copays, deductible, and premiums increases.  The key change for 2025 the Inflation Reduction Act and its impact on prescription drug plans and pricing. As if beneficiaries didn’t already have enough stress trying to manage their Medicare, the 2025 Annual Enrollment Period is likely to create some anxiety but it doesn’t have to.  Below are some thoughts on helping you navigate AEP successfully.

The Inflation Reduction Act (IRA) has a monumental change with the prescription drug side of the equation starting in 2025.  The infamous coverage gap or “donut hole” is ending in 2024 and beginning in 2025 the prescription drug structure is simplified with a $2,000 maximum true cost for covered prescription drugs. Whether you are covered by a Medicare Advantage with Prescription Drug plan (MAPD) or a standalone Prescription Drug Plan (PDP), you are likely looking at changes. 

These changes include but are certainly not limited to (1) elimination of previously offered plans, (2) higher copays for medical services, and (3) higher copays or coinsurance for prescription drugs.  With all of these changes, it is critical to not overlook the basic coverage components of your Medicare Advantage plan choices.  This is important this year because the insurance companies may have shifted some of the increased costs they have to pay for the Prescription Drug side of the equation to consumers. These include:

• Premium
  Each Medicare beneficiary is different and some are okay with a premium where others may look for a $0 premium plan. 
  
  
• Maximum Out of Pocket (MOOP)
  The maximum out of pocket costs are your stopping point for the year for Medicare covered services.  Did this number change? Do you need to look at other options which have a lower out of pocket?
  
  
• Copays for Medicare covered services.
  You may be seeing changes in the costs to see your specialist with higher copays or there might be other covered services such as hospital care.  Do these increases still work for you or could there be other options worth looking at?
  
  
• Are your Prescriptions Covered?  
  This might be the most important piece.  It is critical this year to ensure that the prescription drugs you rely on are covered by the plan you are either currently or considering enrolling in. 
  
  
• Are your Doctors Still In Network? 
  Networks do change from year to year and making sure your doctor is still available for you is always important.

A knowledgeable Medicare Insurance Agent who specializes with the various Medicare options, represents a diverse number of carriers, and who can present to you a number of options that will meet your needs will ensure you manage this AEP without overlooking any of the basics features of your coverage that are most important to you.

Steve Wilson has worked in the health insurance industry for nearly 30 years including nearly 10 within the Medicare space.  He enjoys educating consumers about Medicare and their choices.