Four Choices You Can Make During Medicare’s Fall Enrollment Period

Four Choices You Can Make During Medicare’s Fall Enrollment Period

October 07, 2022

Note: A replay of Canby Financial Advisors’ webinar, Exploring Your Medicare Options, originally presented on October 6, 2022, will soon be available. When it's live, a link to it will be posted to the webinar area of Canbyfinancial.com. Canby Financial Advisors also offers a free Medicare Education Guide. To get your copy, contact your Canby Financial advisor or contact us.


Medicare’s fall enrollment period is here. During this time, which starts on October 15 and ends on December 7, you can take the following four actions to change your current coverage:

1. Switch from one Medicare Advantage plan to another

An all-inclusive alternative to Original Medicare, Medicare Advantage plans are offered by health insurance companies. Medicare Advantage pays for some (but not all) inpatient and outpatient healthcare and prescription costs covered by Medicare.

If you’re unhappy with your current provider, you may be able to switch plans and providers during the fall enrollment period. Options vary by state. 

2. Switch from Medicare Advantage to Original Medicare

If you’re unhappy with Medicare Advantage in general, you can switch to Original Medicare during this period. Coverage generally consists of four components:

  • Medicare Part A, which covers some (but not all) costs of inpatient hospital care; skilled nursing facility care; short-term inpatient care in a skilled nursing facility; hospital care; and short-term home health care.
  • Medicare Part B, which covers some of the costs of services or supplies to diagnose or treat your medical condition; preventive services to detect and treat illness; ambulance services; medical equipment; outpatient treatment services; partial hospitalization; and limited outpatient prescription drugs. Part B monthly premiums for 2023 will be $164.90, a decrease of more than $5.00 from 2022.  (Subscribers with higher annual income may pay more.) Any costs that aren’t covered, including copayments and deductibles, subscribers generally have to pay for out of pocket.
  • Medicare Part D prescription drug coverage (optional) pays for some, but not necessarily all, prescription costs not covered by Medicare Part B. Part D plans are usually offered by a variety of different insurance companies. The best way to choose a provider is to see which plans cover your current prescriptions. Premiums vary.
  • Medigap coverage (optional) is supplemental insurance designed to pay for healthcare costs not covered by Medicare Part B, including copayments, coinsurance payments and deductibles. There are usually a variety of different Medigap plans and providers available in your state. Premiums vary.

While Original Medicare premiums usually cost more than Medicare Advantage plans, your healthcare choices are not restricted. You’re entitled to visit any physician, hospital, or treatment center that accepts Medicare, wherever you are. That may make Original Medicare a better option if you plan to live in another state during part of the year.

3. Switch from Original Medicare to Medicare Advantage

Why would you do this? Because premiums for Medicare Advantage are often significantly lower than those for Original Medicare. Most Medicare Advantage plans also include prescription drug coverage.

However, with a Medicare Advantage plan you usually have to pay deductibles and co-payments for treatment out of pocket. And coverage is often limited to physicians and facilities available through the plan’s network.

If you use an out-of-network hospital or physician, your Medicare Advantage provider may not pay for these healthcare costs. That’s why if you live in another state part of the year, Medicare Advantage might not be an ideal option.

4. Switch Medicare Part D providers or drop coverage

Your choice of Medicare prescription drug plan providers should generally be based on whether the provider covers your current prescriptions. If your current provider stops covering your prescription (which sometimes happens), you change brands or you add a new prescription that isn’t covered by your provider, you can look for a new Medicare Part D provider during this period or choose to drop your Part D coverage.

Don’t confuse open enrollment with special enrollment

There’s only one other time per year when you can change some of your Medicare options. That’s during Medicare’s Special Enrollment Period, from January 1 to March 31. During this period you can usually:

  • Change from one Medicare Advantage plan to another.
  • Switch from Medicare Advantage to Original Medicare plus optional Plan D and Medigap coverage, if allowed.
  • Change Medicare Plan D providers (if you’re on Original Medicare)

During the special enrollment period, you can’t switch from Original Medicare to Medicare Advantage.

Understanding your options

You can only make one change per year, so if you’re thinking of varying your coverage it’s important to understand the pros and cons of any changes you're considering. Fortunately, help is available. Every state has a State Health Insurance Assistance Program (SHIP) where consultants are available to work one-on-one with you at no charge to help you understand and evaluate your available Medicare options. You can locate a SHIP counselor in your area by visiting the SHIP web site at https://www.shiphelp.org.

 

This material has been provided for general informational purposes only. Although we go to great lengths to make sure our information is accurate and useful, we recommend you consult a qualified Medicare consultant for specific Medicare-related assistance.

 

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This article was authored by Chris Gullotti and Jeffrey Briskin. Chris is a financial advisor and Partner located at Canby Financial Advisors, 161 Worcester Road, Framingham, MA 01701. He offers securities and advisory services as an Investment Adviser Representative of Commonwealth Financial Network®, Member FINRA/SIPC, a Registered Investment Adviser. He can be reached at 508.598.1082 or cgullotti@canbyfinancial.com  Jeffrey Briskin is Director of Marketing at Canby Financial Advisors.

 

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