Medicare Open Enrollment: What Seniors and Their Families Need to Know

School is in full swing, football fans are sporting their team colors and the holidays will be upon us before we know it.  All of this can only mean one thing: it’s time for Medicare Open Enrollment!

Medicare Open Enrollment for 2023 begins October 15 and runs through December 7. The annual open enrollment period is designed to give Medicare recipients the chance to review their Medicare Advantage or Pt. D prescription drug plans to ensure each plan best serves their individual needs.

A Brief Refresher on Medicare

Medicare has evolved since its inception in 1965. Modern Medicare is made up of four parts:

Part A covers hospitalization and hospice care. Part A does not cover “ordinary” medical expenses, however, so individuals without other insurance generally need to enroll in Medicare Part B, too.

Part B covers visits to your doctor, diagnostic testing, and other outpatient services. You might think of Part B as your general health insurance, as it covers more routine medical needs that Part A does not.  Parts A and B  comprise “Original Medicare.”

Part C is private health insurance through Medicare Advantage Plans, which combine coverage found in Parts A and B.   Medicare Advantage Plans are offered by private insurance companies and actually replace Original Medicare Parts A and B for recipients who choose to enroll.  According to KFF (formerly known as Kaiser Family Foundation), in 2023, 30.8 million people are enrolled in a Medicare Advantage plan.  This is slightly over half of all those eligible for Medicare.   To enroll in a Medicare Advantage Plan, you must first be enrolled in Parts A and B.

Part D are plans for prescription drug coverage.  Part D is optional, and plans are entered at the county level with private insurers.  Some Medicare Advantage Plans include prescription drug coverage, but not all do.   You can shop for and enroll in Part D plans on the www.Medicare.gov website.

These parts are designed to work together to cover most of the medical needs of seniors, but there are deductibles and copays with Medicare.  Many individuals covered by Original Medicare choose to purchase a Medicare Supplement Insurance policy that pays Medicare deductibles and copays.  In other words, the supplemental insurance picks up some of those out of pocket Medicare costs.   Enrollees who are covered under a Medicare Advantage Plan are not eligible for a Medicare Supplemental Insurance policy.  There is a fairly limited time of open enrollment for supplemental insurance.  It is beyond the scope of our discussion here, but you can learn more about it on the Medicare website.  The annual open enrollment applies to Medicare Advantage Plans and Part D Plans.

Making the Most of Open Enrollment

According to the results of a KFF study published October 13, 2021, a staggering 71% of Medicare beneficiaries surveyed did not compare plans during the 2018 open enrollment period, including those already enrolled in a Medicare Advantage plan. Overall, only 29% of all Medicare beneficiaries compared plans. The older or less wealthy a beneficiary is, the less likely they are to compare plans—precisely the individuals who might benefit most from doing so.

Choosing an appropriate Medicare Advantage or prescription drug plan can provide beneficiaries with better coverage, lower premiums and, in some cases, both.

There are a few steps all Medicare beneficiaries should take to ensure that they make the most of the Open Enrollment period:

Review changes in policies. If you are currently enrolled in a Medicare Advantage, you should be sure to review any upcoming changes to your policy that may take effect at the new year. Be sure to check your mail, email, and customer portal (if your client offers one) and keep an eye out for notices of changes to your policy.

Understand and assess your current coverage. Review your current policy benefits, keeping in mind any changes that may soon be made. Reflect on what your medical needs are likely to be for the coming year, including prescriptions, and assess whether your current coverage adequately provides for your needs in a cost-effective manner. You may find that paying a little more up front in premium can save you costs in the long-run, or on the other hand, you might decide that the benefits of your plan far exceed your current and anticipated needs.

Preview Pt. D prescription drug plans for 2024. Take a look at the available plans for the upcoming year to see whether any better meet your specific needs. In addition to monthly rates, copays, or deductibles, be sure to consider whether your preferred doctor, health providers, and pharmacy are listed as “in-network” for that plan. You can review new plans online at medicare.gov or by phone at 1-800-MEDICARE, and consider consulting the 2024 Medicare & You handbook.

What Can Be Changed in Open Enrollment

October 15 – December 7

• Join, drop, or switch to another Medicare Advantage Plan (or add or drop drug coverage)
• Switch from Original Medicare to a Medicare Advantage Plan
• Switch from Medicare Advantage Plan to Original Medicare
• Join a Medicare Pt. D drug plan if you are in Original Medicare
• Switch from one Medicare Pt. D drug plan to another in you are in Original Medicare

Florida’s SHINE Program

Need help reviewing your current plans and choosing a new one? Be sure to take advantage of Florida’s SHINE Program, a FREE service of the Florida Department of Elder Affairs and your local Area Agency on Aging.  SHINE (Serving Health Insurance Needs of Elders) provides health insurance information and unbiased, confidential counseling to Medicare beneficiaries, their families, and caregivers. The program’s website offers a number of free, downloadable resources to help beneficiaries understand Medicare, the enrollment process, and various coverage choices. To access the SHINE Program’s free counseling services in Polk County, call 1-800-963-5337 or visit their website to view the available counseling sites in Polk County.

Beware of Scams

The Medicare Open Enrollment period is rife with scams. Scammers often contact Medicare beneficiaries claiming to work on behalf of the federal government or Medicare Advantage plan providers. Never discuss private information with someone who calls you and claims to be from one of these organizations. If in doubt, hang up and call that organization directly (do not simply redial), or opt to provide that information via secure, official websites.

Editor’s Note: This post was originally published in October of 2021 but, as of September 2023, has been edited for accuracy and comprehension