Falling Leaves, Pumpkin Spice, and MOE
MOE, Medicare Open Enrollment
Fall is in the air, and pumpkin spice flavor infuses everything from lattes to Oreos. Your mailbox overflows with offers to change your Medicare insurance plan. It all becomes very confusing. Every year from October 15th to December 7th is MOE (Medicare Open Enrollment). If you care for an elderly parent or loved one, they will probably need your help.
What is open enrollment anyway? Why the onslaught of snail-mail fliers and flooded inbox with email offers? Open enrollment is the period each year when you can make changes to your Medicare Plan. Insurance companies want your business. Hopefully, if you’re Medicare eligible you have signed up for Medicare A and B. Basically, A covers hospital stays and B is outpatient services.
D is a prescription plan and C is Medicare Advantage Plans. Advantage plans are managed Medicare. The companies contract with Medicare to provide insurance services, which they then “manage” for you. You have fewer decisions to make but also less choice. Advantage Plans usually have “gatekeepers” — you usually need to get a referral before seeing a specialist. Which doctors and specialists you can see are limited. They emphasize wellness programs. Some offer programs through fitness centers so that you can use gym equipment and attend senior fitness classes if you qualify. Silver Sneakers is one such program. https://www.silversneakers.com/
So what exactly can you do during open enrollment?
This is a list from the aging.com website
• Change from Original Medicare to a Medicare Advantage Plan.
• Change from a Medicare Advantage Plan back to Original Medicare.
• Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
• Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that does offer drug coverage.
• Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
• Join a Medicare Prescription Drug Plan.
• Switch from one Medicare Prescription Drug Plan to another.
• Drop your Medicare prescription drug coverage completely.
• Do nothing. If you don’t make any changes during MOE, your existing plan(s) will roll over at the end of the period and your existing coverage will remain in effect.
Insurance, Shopping or Just Browsing?
You can shop around and get quotes from different companies. Just be sure you are comparing apples to apples. Factor in not just premiums but also deductibles and co-pays. Before you choose a drug plan, make sure they cover the drugs you are taking. I changed last year and found a common prescription I’m on, is not covered by the plan. I made sure the big-ticket items—the drugs I know are expensive are covered but didn’t think to ask about something so common. It didn’t even occur to me to check for coverage. Surprise! They don’t cover it—at all.
In my past life, I answered a phone line about insurance plans and medical issues. One of the questions I often got was, “What do I do if I don’t want to change anything.” Nothing! The plan you are on will roll-over for next year if you don’t make any changes. Another popular question was, “Oops, I missed the Open Enrollment Period, what do I do?” (Often this followed, “I was traveling in Europe for six months and didn’t get my mail.” I was so jealous!). You may need to wait until next year to make changes to avoid payment penalties. There are exceptions, though. If you sign up for an Advantage Plan and don’t like it, you can disenroll but you only get until February 14th to make that change. So, if you don’t love your Advantage plan you have to “break-up” by Valentines Day. To make any other changes you need to have a “life qualifying event”. Life qualifying events are things like losing your current coverage via job loss, the insurance company no longer offers benefits in your area, or life status change.)
You should be able to find the answers to any questions here:
A caveat being, you often need to know what you’re looking for in order to find it. Also, all the nuts and bolts of what’s covered aren’t there because they relate to “medical necessity.” Certain medical conditions qualify you to receive some benefits as they are deemed necessary for someone with say, diabetes, but not for non-diabetics. These are my general statements and not legal statements. Very specific language is used in benefit explanations to avoid legal issues, so don’t take my words as gospel. I’m just trying to give you a sense of how specific medical terms decide what’s covered. https://www.medicare.gov/coverage/foot-care.html
It is a strange and convoluted process. You can begin to see why physicians and laypeople both get frustrated with medical service and coverage. Sometimes the insurance company gets blamed for what is federally mandated law under Medicare. Insurance companies can’t offer you less than what Medicare covers. If they offer more, it is because their philosophy is early intervention and treatment is more cost-effective in the long run.
For those of us caring for our own health and that of an elderly loved one and it quickly becomes overwhelming. My advice— tackle it when you’re rested. Get advice if you need it. Financial advisors can help. If you get overwhelmed, let it sit for a day or two and come back to it. Don’t sign up until all your questions are answered. If you’re a bargain hunter who loves price comparing and shopping for the best deal, you’ll love this time of year! When you’re finished, have a pumpkin spice latte. You can have mine too—I think they’re gross. I’ll take a piece of pumpkin pie, though, thank you very much.
Have a great caregiving day,