It’s the time of year to review your Medicare coverage. Open enrollment runs from Oct. 15 until Dec. 7, a seven-week window to think about your health care needs for 2022 and decide whether you should make any changes in your coverage.
Even as Medicare beneficiaries juggle getting COVID-19 vaccine booster shots and taking care of health needs that may have gone wanting during the height of the pandemic, experts urge older adults to take the time to make sure they have the coverage that's best for them.
“It's a question of what people need to think about; about what's most important to them,” says Tricia Neuman, senior vice president and director of Medicare policy at the nonpartisan Kaiser Family Foundation (KFF). For example, she says, taking time to make sure your prescription drugs are covered at the best price "could really mean a difference of hundreds or even thousands of dollars.
During open enrollment, enrollees get to decide whether original Medicare or Medicare Advantage (MA) — an alternative that relies on private health insurance plans — is best for their health needs. During this period, you can switch from original to MA or shift from an MA plan back to original Medicare. You can also change MA plans — there are multiple plans from which to choose. And you can decide whether to enroll in a Part D prescription drug plan or change plans if you already get your drugs through a Part D policy. Any changes you make will take effect in January 2022.
To help you make this decision, you need to consider all of Medicare’s parts. Part A covers hospital and hospice care, as well as some skilled nursing services following a hospital stay. Part B includes doctor visits, diagnostic tests and other outpatient services. Part C is Medicare Advantage, which combines Part A, Part B and — usually — Part D, which helps pay for prescription drugs.
Neuman says it's unfortunate that the large majority of Medicare beneficiaries do not take advantage of the annual open enrollment period. In the latest Medicare beneficiary survey, 71 percent of enrollees said they had not compared the plan they were enrolled in with other options available to them.
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"People find the process overwhelming and frustrating," Neuman says. "There are often dozens of plans in their area and many people find it very difficult to make comparisons.I think people are aware there's an open enrollment period. They're inundated with marketing materials but may feel either ill-equipped to compare plans or find the process too hard and frustrating so they just throw up their hands" and stick with the coverage they have. But Neuman urges enrollees to take the time to review their coverage because it can pay off in their ability to get the care they need at a cost they can afford.
Tips for picking the right coverage
Neuman has some advice about how to proceed: Don’t just look at a plan’s premiums. That’s the easy part. And they aren’t the best gauge of what your total out-of-pocket costs will be during the year.
- If you are considering a Medicare Advantage plan, check out whether the doctors you see are in the plan’s network. Going out of network can cost you more.
- Make sure all the drugs you take are covered either by your MA plan or by a Part D plan. Taking a drug that isn’t covered or isn’t considered a “preferred” medication could mean you’ll pay more out of pocket.
- Copays differ among the plans, so be careful to look at what the 2022 costs
- Check out whether your local drugstore is considered a preferred pharmacy in your plan; if it is, you'll pay less for your prescriptions there.
The best place to start to make your comparisons is the Centers for Medicare & Medicaid Services (CMS) plan-finder website. The medicare.gov home page will guide you through your enrollment journey. You can compare coverage and costs between original Medicare and MA plans, and get detailed information about Part D choices. The site also includes a cost calculator. You can also chat live with a CMS representative or call the toll-free Medicare hotline, 800-MEDICARE (800-633-4227), 24 hours a day, seven days a week. State Health Insurance Assistance Program — or SHIP— counselors are also available to help in every state.
New for 2022
CMS continues to expand the availability of telehealth benefits, particularly amid the COVID-19 crisis. Virtual check-ins with doctors and other health care providers are available to all Medicare beneficiaries.
Medicare Advantage plans also continue to expand the availability of extra services, particularly for the 73 percent of beneficiaries who have chronic health conditions. These benefits may include meals at home, transportation to health appointments, nutrition counseling or safety improvements to your home. Not all MA plans offer these benefits, so look carefully at the coverage descriptions on the plan-finder site.
Average monthly premiums for Medicare Advantage plans are expected to drop in 2022 to an average of $19, and Part D prescription drug premiums are slated to increase slightly to an average of $33 a month. These are just estimates. Actual premiums and out-of-pocket costs vary for MA and Part D plans based on which plan you select, what it covers and where you live. CMS has not yet announced 2022 premiums and deductibles for parts A and B.