Take Advantage of Marketplace and Medicare Open Enrollment!
Betty Chaffee, PharmD, is owner and sole proprietor of BetterMyMeds, a Medication Management service devoted to helping people get the maximum benefit from their medications.
Medicare and the Health Insurance Marketplace both have an annual open enrollment period. They usually run at about the same time, though with slightly different start and end dates. This year, the Medicare open enrollment period started last week. It runs through December 7th, and new policies will be effective January 1, 2022. If you're signing up for insurance through the Affordable Care Act (ACA) Health Insurance Marketplace, open enrollment starts November 1. Your policy will be effective January 1, 2022 if you complete the process by December 15. If you're in no hurry for coverage, the ACA's open enrollment actually goes all the way through January 15, 2022.
What is open enrollment?
Typically, once you choose a health insurance plan you're locked into it for a period of time. There are exceptions to that rule for significant life changes. Marriage or divorce, retirement, or a new baby are some examples of those life changes. When something like that happens you can often make changes in your health plan right away. But other than that, you're usually locked in to a plan for the duration of the year.
Open enrollment is a period during which you can choose to change your health insurance plan without a specific reason. That's true for most employer-based plans as well as Medicare and ACA-based plans. And it's a good thing to look closely at your health insurance plan every year. Though it takes some time and thought, it can save you money and frustration in the long run. Here are some reasons comparing plans every year can help:
Deductibles, co-pays, and co-insurance may change.
Doctors may move in or out of network.
Prescription co-pays or deductibles may change.
Some medications may move from a low cost category to a high cost category, or not be covered at all.
You may have been diagnosed with a health concern that requires specialty care.
You may decide to spend time in another state where you'll need care.
And there may be other reasons your current plan may not suit your needs.
The only way to find out is to look at available plans and compare what they offer. If you're already enrolled in Medicare or a Marketplace plan, you have the opportunity at this time of year to look at other plans, and switch to a different one if it'll better meet your needs.
Medicare insurance can be complicated. You have Part A (hospitalization, more or less), Part B (outpatient care, more or less), Part C (like an HMO, more or less), Part D (prescription coverage), and Medigap policies (lots of other letters). You can get more detail on all those "parts" from our previous articles on Medicare Insurance and Medicare Prescription Coverage.
I've found the Medicare website to be relatively user-friendly. You'll find help deciphering the different Medicare "parts" and even locating professional assistance if you need it. You'll find plans available in your area, then you can filter the results based on cost, desired benefits, or other aspects of coverage. The website will allow you to enter the medicines you take also, so that you can compare prescription drug costs from one plan to another. Just be prepared to spend a little time (ok, maybe more than a little). I recommend signing up for an account instead of just going ahead without one. Information you enter will be stored securely, and if you need to pause and come back later you won't have to enter all the information in again.
ACA's Health Insurance Marketplace
The Healthcare Marketplace website had some problems when it was initially rolled out some years ago. But it's evolved, and millions of people have used it to sign up for health insurance plans. Like the Medicare website, it'll help you find local experts who can assist you comparing plans. This one is a little different though, in that available plans are based also on income, not just where you live and what benefits you need. For that reason, the registration process may be a bit more time-consuming than with Medicare. But the end result will be similar, you'll get a list of available plans. You may have low, moderate, and high cost plans to choose from, with coverage ranging from bare bones to extensive.
Mark some time on your calendar to compare!
If you've had health insurance through the Marketplace or Medicare, and haven't looked at other options for a couple of years. take some time to compare plans this year. Be prepared to register for an account on the website, and be confident that your information will be securely stored. Think ahead about what benefits are important to you, and what your cost limitations are. And be sure to look carefully at all of the costs so there are no surprises -- annual deductibles, premiums, co-pays/co-insurance, and services that may not be covered at all.
If you have experience with either of these websites, please share advice with other readers. And as always, we welcome your comments and question below. Or you can always contact us directly at BetterMyMeds!
Thank you for sharing this information, Betty! I know that this can be very confusing and frustrating for a lot of people. I do endorse the Medicare website https://www.medicare.gov/plan-compare/#/?lang=en&year=2022 that you shared, but even that can be a little confusing for some. Here are a couple of points that I’d like to share:
1. Pharmacists/pharmacies are NOT permitted to endorse or persuade a patient to select one plan over another. We can help point out differences between plans you qualify for, but we cannot outright suggest which plan we would choose for you.
2. If a patient takes potentially expensive medications, he/she may consider a plan with a lower deductible that would need to be met at the beginning of the calendar year. Otherwise, the patient may end up paying pretty high out-of-pocket costs to satisfy this deductible.
It is sad that Medicare plan selection has to be so confusing. I imagine that it’s the fault of the insurance companies and the federal government does not want to overstep state desires. I’m hoping that the Medicare extension plan gets approved so that hearing, dental, and vision care will be included. Alan, you say that the pharmacists are not permitted to endorse any one plan but wouldn’t they be the entity that would be the most useful for someone that has a lot of prescriptions? I would think their knowledge would be better than someone else.
I’m with you, Tony. Medicare for sure should cover dental and hearing. Some of the Medicare Advantage plans (Part C Plans) already do that, but not traditional Medicare.
And pharmacists certainly can help. As Alan said, we’re allowed to tell you what plans cover our products and services, and we can even help you compare plans in terms of prescription costs, deductibles, and premiums if they’re filled at a particular pharmacy. We just can’t go one step further and recommend one.