Medicare's Annual Enrollment Period (AEP) begins October 15 and runs through December 7. This is the dedicated time during the year when seniors can switch their Medicare coverage without the need of special circumstances. Unfortunately, it can be a maze for many people. I've encountered countless individuals who've grappled with questions about Medicare plans, prescription coverage and the financial implications of their choices. As a senior benefits specialist, I'd like to provide you with some insight to simplify your journey through the 2024 AEP season, including some changes and things to look out for. Plus, I’ll provide some information on how to get support as you navigate all of the plan options available for 2024.
Deciphering Drug Costs and Changes in Formularies
Cost Saving Legislation
In 2023, we've already seen a cap on insulin costs for Medicare members, which has been a great benefit for many insulin users. Starting in 2024, Medicare members who frequently enter the "catastrophic phase,” those with very high prescription drug costs, won’t have additional prescription costs during that phase. Also new for 2024, if your income is below 150 percent of the federal poverty level, there will be extra help for your prescription costs. In 2025, there are plans for a $2,000 annual cap on out-of-pocket prescription costs that includes the flexibility to distribute those costs over the year, rather than a one-time payment.
Make Sure You’re Covered
The new regulations for prescription drug cost savings will be wonderful, but make sure you know if there will be any changes to your drug coverage on your current plan, too. For example, while the insulin cap is set at $35 a month, items such as syringes and test strips aren't included within the cap. Every year, by September 30, you should receive an Annual Notification of Change (ANOC) which outlines any changes in coverage for your current Medicare plan. My main advice is to double-check the formulary of your plan, which is the list of drugs covered, when you receive your ANOC to ensure your medications remain covered and affordably priced. If they’re not, it may be time to consider shopping for a new Medicare plan.
Coverage for New Alzheimer’s Drugs
Finally, there's been a lot of anticipation for a new type of drug to help treat Alzheimer’s disease. At this time, the drug has received traditional approval by the FDA, which means it'll be covered by Medicare under Part B. If you're on Original Medicare, expect to pay the usual 20 percent coinsurance for this new treatment, called Leqembi, once your Part B deductible is met.
Those with supplemental Medicare coverage or other secondary insurances might have different costs. And if you're part of a Medicare Advantage plan, it's best to reach out to your insurance carrier for precise cost details. It’s important to note that, while the drugs are covered under Medicare, there is a strict process to determine if someone is eligible to receive them. For that, you’ll need to consult with your doctor.
Understanding Medicare Part B Givebacks
Medicare Part B givebacks, also known as Social Security givebacks or Part B premium reductions, are a benefit featured on some Medicare Advantage plans that have been advertised more often in recent years. They can be confusing at first glance, so let’s break down how they work.
Some Medicare Advantage plans offer this benefit as an added perk that allows members to receive money back into their Social Security check every month. If someone isn’t currently receiving Social Security, the benefit would be applied directly to their Part B premium. For instance, I have a client who, thanks to this benefit, doesn't pay his Part B premium at all. The amount given back can vary widely, anywhere from a few cents to more than $100. If you’re unsure whether your plan offers this, check your Summary of Benefits or call your insurance carrier to confirm. It’s important to remember, just because getting money back each month sounds appealing doesn’t mean the plan is the best fit for you. Make sure the plan fits all your needs before enrolling.
Considering Dental Coverage in Medicare
More and more Medicare Advantage plans are now offering dental benefits, something that Original Medicare doesn't provide. It's an appealing feature for sure, but based on my experience, there can be some fine print to consider.
Just because a plan offers dental coverage doesn't mean your dentist accepts it. My own dentist, for instance, doesn't work with Medicare Advantage Prescription Drug (MAPD) dental plans. So, don't let dental coverage be the sole reason you choose a medical and drug plan. Before deciding, call your dentist and ensure they accept the plan you're considering. It'll save you a lot of hassle later.
Resources for Better Decision-Making
Whether you’re shopping for Medicare for the first time, or looking to switch your plan, it can be confusing and exhausting looking at all the options. Here are some helpful tips and resources to aid you in the process:
Beware of Red Flags
Scammers know the AEP season is a hectic time for many seniors and they’ll use that to try to take advantage of you. There are many legitimate call centers that may reach out, but I would advise the following to make sure you protect yourself:
- Ask to meet them face-to-face, whether that is in-person or over a video call. Make sure the person who called you is a licensed agent with professional knowledge, not just someone working from a script in a call center.
- Get everything in writing with proof. A licensed agent won’t have a problem confirming details in writing for you.
- Don’t give out confidential information over email or the phone to a “cold caller.” Again, make sure you’re speaking with exactly who they say they are before providing any confidential or personal information.
Use Online Tools
If you’re comfortable doing some of your own research, one of the most reliable websites is the official Medicare.gov page. This website is run by the government Medicare program, so it’s trustworthy and lets you compare drug costs and get the latest on plan changes. Think of it as a 24/7 tool right at your fingertips, allowing you to understand your healthcare choices on your own time.
The Role of Licensed Agents
Working with a licensed agent can be a game-changer when navigating the world of Medicare. I always tell seniors that a good agent doesn't just offer advice—they back it up. Here's what you can expect from a trustworthy agent:
- Proof of advice: Whenever I offer advice, I provide concrete evidence to back it up. If I'm recommending a plan based on your medications, I'll show you a printout from medicare.gov detailing the costs. It's essential to have written proof for everything, ensuring you always have a reference point.
- Guidance and advocacy: An agent serves as your advocate, simplifying all Medicare jargon. Whether you're a frequent traveler or have significant prescription drug costs, an experienced agent ensures you get the best plan tailored to your needs.
But remember, preparation is key! Before meeting with an agent, gather these crucial details:
- List of your doctors, including specialists
- Your current prescription drugs with their names and dosages
- Your budget, and if possible, the total out-of-pocket medical expenses from the past year
- The latest ANOC or details of your current plan
- Your Medicare Advantage member ID, the red, white, and blue Medicare card, and/or your Prescription Drug Plan card
Having all this information on hand simplifies the process, making sure you get the plan that truly fits your lifestyle.
Investigating the intricate world of Medicare can be confusing and complex—but you have access to plenty of resources to help you along the way.
If you’re thinking of changing your healthcare coverage for the 2024 AEP season, it's a wise move to touch base with a licensed Medicare agent first. Licensed agents are equipped to provide unbiased, personalized advice, ensuring your preferred doctors and medications are covered. They're here to streamline the process and make sure your choices truly fit your needs. With their help, your 2024 enrollment can be straightforward and worry-free.
Ready to make Medicare simple? Talk to a licensed Medicare agent today and step confidently into 2024. Visit pcf-sb.com to get started.