Most seniors aged 65 or older are aware that the Medicare Annual Enrollment Period (AEP) begins October 15th and ends December 7th. It is the busiest time on the Medicare calendar because it is the period, every year, during which you may change your Medicare Advantage Plan (MA)* or your stand-alone Medicare Prescription Drug Plan (PDP).
*MA refers to Medicare Advantage Plans AND Medicare Advantage Plans that include Prescription Drug coverage (MAPD).
And remember, if you change plans, there are no pre-existing condition exclusions or waiting periods to limit coverage!
Here’s What’s Happening
Although AEP begins October 15th, plans and agents are permitted to disclose plan-specific benefits and cost sharing as early as October 1. Disclosing 2023 specific plan details prior to October 1 is strictly prohibited by the Medicare Agency (CMS). The good news is Congress has increased funding for MA, MAPD, and PDPs for 2023, which means it is highly likely that your plan will improve for 2023. SIGNIFICANTLY!
If you are enrolled in a MA or MAPD, please be careful to look for the Annual Notice of Changes document (ANOC) that CMS requires to be in your possession by October 1. This document focuses only on each benefit and cost sharing that will change or will be added to your plan on January 1, 2023. The ANOC is very easy to read and understand.
Please ignore ALL advertising until you have studied the ANOC for your plan! If you are happy with your current plan, you will probably be very happy with your plan for 2023. If you aren’t happy with your current plan, you may learn that changes in your plan for 2023 might resolve your issue(s). And you’re safely done.
Once you have carefully studied the ANOC, get a copy of the Summary of Benefits and the Formulary for your plan for 2023.The Summary of Benefits will provide more detail on all benefits and copayments, while the Formulary will list ALL prescription medications covered by your plan for 2023. If your plan does not provide a copy of these documents, call your agent, or visit the plans website for a copy. As a last resort, contact Member Services.
If you have any questions upon reviewing the ANOC, Summary of Benefits, and the Formulary, call your agent. Your agent received a commission to enroll you and continues to receive a commission to service your plan. If your agent isn’t interested in answering your questions, change agents.
What You Should Do Next
So, what is the point of all of this? Very simply, if you’re happy with your current plan, and it improves for next year, do you really need someone to help you understand what is best for you for 2023? If you are happy with your current plan, and it improves for 2023, isn’t it very likely you will be very happy with your plan in 2023?
The single largest source of complaints submitted to CMS by seniors is due to enrollment in a new plan. Issues like “my doctor isn’t in the new plan” or “all of my prescriptions aren’t covered by the new plan” can be easily avoided by staying put.
Can your needs change in a given year? Of, course. But be careful to not fall prey to the voluminous advertising asking you to call 1-800 whatever, to make sure you learn about getting everything you’re entitled to. You may learn you are entitled to troubles.
My last piece of advice is to work with an agent who is licensed to advise and enroll in the same community where he/she works and lives. When you have questions or need help, that is the person to whom you can turn for help.
Just be careful. “If it ain’t broke, don’t fix it” is very sage advice.
