Healthcare needs are ever-evolving, and an unexpected illness or injury can cause huge financial hardship. The need for better Medicare coverage has never been more important, and failing to reevaluate coverage annually during open enrollment can be an expensive mistake. Recent research showed that 20% of senior adults paid too much for their Medicare last year, by as much as $500. Mistakes like these can be avoided, however.
The last several years have seen major changes and updates to Medicare coverage, and many additional options were added – but all these options can be confusing. The average person had nearly 70 different Medicare private plan options to choose from last year, including 43 Medicare Advantage plans. In fact, in 2023, there are two-thirds more plan options available than there were just a few years ago.
Annual Medicare coverage is established during an annual open enrollment period, this year taking place between October 15 and December 7. This window provides an opportunity to once again evaluate coverage, compare costs, add features, and hopefully save money for 2024. As you look into options, remember that some changes in plan will alter premiums, out-of-pocket costs, and access to prescription medications – as well as provider and pharmacy networks.
Did You Know? Most people do not reevaluate their plans annually. Among the 11.3 million Medicare Advantage enrollees in 2019, only 10% voluntarily switched plans for 2020.
Annual open enrollment provides an opportunity to improve or enhance coverage and help save money. Here is the information you need to know. This blog is for informational purposes only – please consult with a professional or read more here.
Original Medicare
The original and most common form of Medicare coverage is issued by the federal government. Enrollees have access to any doctor or hospital that accepts Medicare anywhere in the United States. Original Medicare covers most medically necessary services and supplies in any healthcare facility. In most cases, a referral to see a specialist is not required, which does represent a significant benefit. While original Medicare did not include routine dental care, the program is expected to expand the “medically necessary” dental services program when combined with other necessary procedures.
Original Medicare comes in two parts: Part A (Hospital Insurance) and Part B (Medical Insurance).
Part A: This coverage includes inpatient hospital stays, skilled nursing center care, hospice care, and selected home health care. While many plan participants do not have to pay a monthly fee, there are associated limitations, deductibles, coinsurance, and other out-of-pocket costs.
Part B: This coverage includes physician visits and services, most medically necessary equipment — including wheelchairs and walkers — mental health services, hospital outpatient services, diagnostic tests, some vaccines, as well as some therapy and preventive care. Enrollees in Part B (including those in Medicare Advantage) are required to pay a monthly premium.
Two additional parts were subsequently added to the original Medicare: Part C (Medicare Advantage) and Part D (Drug Coverage).
Part C: Medicare Advantage is administered by private health insurance companies, offering a privately managed option for health and drug coverage. MA plans include dental coverage and may have lower out-of-pocket costs than original Medicare. MA requires the use of healthcare providers who are in the plan’s network and service area, and referrals may be necessary. There are several MA plans to choose from – in 2023, the average Medicare beneficiary could choose from among 43 MA plans.
Part D: This optional coverage includes pharmaceuticals and some vaccines for everyone with Medicare. Those with original Medicare can select a stand-alone Part D plan, and some MA plans also offer Part D coverage.
Additional Enrollment Changes
This season, Medicare will be able to negotiate medication prices with drugmakers, improving affordability. The Inflation Reduction Act of 2022 provides for changes to Part D that will potentially reduce prescription drug costs for enrollees. Catastrophic coverage deductibles under Medicare Part D will also change.
Open enrollment begins October 15. Read more here and consult your financial or healthcare advisor for more information.
A Banyan Residence is an assisted living and memory care center located in The Villages.
