Are your elderly parents or in-laws on the right Medicare plan?
Medicare’s open enrollment (aka Annual Election Period) is from October 15th to December 7th. The last change on or before Dec. 7th will take effect on Jan 1st 2025.
What current Medicare recipients should do
Should current Medicare recipients look at their policy? Medicare says: It depends on the type of plan currently in place.
- If the plan in place is Original Medicare (aka Part A and Part B) plus a supplemental plan (often called a Medigap) and the recipient is happy with the coverage, a change doesn’t need to be made.
- If the plan in place is Part C (aka Medicare Advantage) or Part D, the recipient should review all the coverage options (even if they are happy with the current coverage) because plans change their costs and benefits every year. To do that, read the Annual Notice of Change (ANOC), which should have been received by September 30. The ANOC lists the changes in the plan, such as the premium and copays, and will compare the benefits in 2024 with those in 2025.
Do some homework before switching to a Medicare Advantage plan
Currently, 54% of Medicare recipients have a Medicare Advantage plan, but not everyone is happy about it. The Pros and Cons of Medicare Advantage by Fortune Well outlines some significant “cons” such as:
- According to a KFF study in 2022, “traditional Medicare” outperformed Medicare Advantage in receiving care in the highest-rated hospitals for cancer care or in the highest-quality skilled nursing facilities and home health agencies.
- The U.S. Health and Human Services Inspector General reports found “widespread and persistent problems related to denials of care and payment,” related to the prior authorization rules specific to Medicare Advantage plans.
- Medicare Advantage plans are permitted to limit their provider networks, the size of which can vary considerably for both physicians and hospitals, depending on the plan and the county where it is offered.
For those turning 65: how to avoid Medicare penalties
Recipients are eligible for initial enrollment in Medicare during a 7-month window, which includes:
- 3 months before a 65th birthday,
- during their birthday month and
- 3 months after their birthday month.
According to Medicare, the best way to enroll in a new plan is to call 1-800-MEDICARE (1-800-633-4227). Enrolling in a new plan directly through Medicare is the best way to be protected if there are problems with the enrollment. Medicare suggests that the recipient take notes regarding everything about the enrollment conversation including the date, the representative spoken with and any outcomes or next steps.
If one doesn’t sign up during the Initial Enrollment period, there can be late enrollment penalties for Parts A, B and D unless the recipient has other coverage that’s similar in value to Medicare (like from an employer.) They also may have to pay a late enrollment penalty.
Late enrollment penalties:
- Are added to the monthly premium.
- Are not a one-time late fee.
- Are usually charged for as long as they have that type of coverage (for most people, that’s a lifetime penalty). The Part A penalty is different.
- Go up the longer they wait to sign up – they’re based on how long they go without coverage similar to Medicare.
More information about late enrollment penalties can be found on this Medicare page.
How do I know what Medicare plan is already in place?
You can find this information a few different ways:
- Look at the recipient’s Medicare card, as this shows: If they have Medicare Part A (listed as HOSPITAL), Part B (listed as MEDICAL), or both and the date the coverage began. With the Medicare number on the card, you can follow the steps to find more information and log into the on-line account here.
- Call the program at 1-800-MEDICARE (1-800-633-4227). You will need the recipient on the phone and/or their permission.
- Check their medicare.gov account which requires access to their username and password. You will also need their zip code, Medicare number, name, date of birth, and the effective date for the Medicare coverage.
- If you have access, sign in to their Social Security account and view the benefit verification letter.
Want help making sense of all the parts and plans?
This two minute video from Medicare provides a helpful summary of what is covered by the A, B, C & D parts of Medicare.
Unbiased guidance on Medicare plans
The State Health Insurance Program (SHIP) provides free and unbiased counseling advice about Medicare programs. The SHIP site has a search by state feature to determine the contact information for your statewide resource.
Alternatively, the National Council on Aging’s Medicare Standards of Excellence list can be used to find agents and brokers working for the recipient’s best interest.
As always, a Ways & Wane Care Advisor is available to support you with navigating care needs including Medicare.
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