Medicare Checklist for 2023 and Beyond

By Kelly Perkins and Scott A. Rojas, CFP®, MBA

The Medicare Annual Enrollment Period (AEP) is here. This is the time frame each year when eligible individuals can make changes to their Medicare insurance coverage for the following year. This period runs from Oct 15th to December 7th and allows beneficiaries to make changes to their current Medicare Advantage plans or Part D Prescription Drug plans. It also allows you to switch from Original Medicare to a Medicare Advantage Plan or switch from a Medicare Advantage back to Original Medicare and enroll in a Part D plan. It is a great time to review your Medicare insurance plan coverage and make sure it matches your current needs.  With so many plans in the area, we know this is not an easy task to navigate.  We have resources both online and have a trusted agent available to meet with you in person.  Below is a quick summary of items to think about as you evaluate your coverage over the next few weeks. 

1. Understand Your Current Coverage

The first step to reviewing your coverage is understanding what you have. Medicare insurance coverage has several options, including Original Medicare (Part A and Part B), Medicare Advantage (Part C), and Medicare Part D (prescription drug coverage.) Do you get your coverage through Original Medicare with a stand-alone prescription drug plan (Part D) and a Supplemental Medi/Gap plan, or do you get your coverage through a Medicare Advantage Plan (Part C)? Knowing this information will help guide you on the changes you can make.

2.  Obtain your Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) documents from your current plan provider.

By now you should have received these documents that outline any changes in coverage, costs, or benefits for the upcoming year.

3. Review Your Health Needs & Medication list

Each year formularies (which is a fancy way of saying covered drugs) will change on both Part D plans and Medicare Advantage (MAPD) plans. AEP is the time to review your medication list and make sure your drugs are still adequately covered by your plan. The price of a medication can vary from plan to plan so it is good to compare.  You will also need to verify that your preferred doctors, specialists, hospitals, and pharmacies are in-network for any plan you are considering. Evaluate if the extra benefits that some Medicare Advantage plans offer like dental, vision, hearing, and wellness programs are important to you.

4.  Compare Costs & Benefits

There are several ways to compare plan changes. You can work directly with an independent insurance agent at no cost to you or you can visit the official Medicare website (www.medicare.gov) and use the Medicare Plan Finder tool which allows you to enter your current prescriptions and healthcare needs to compare Medicare Advantage and Part D plans available in your area. You can also contact your State Health Insurance Assistance Program (SHIP) for help.

5. Review Star Rating

Medicare Advantage plans and Part D prescription drug plans are assigned star ratings by Medicare. These ratings give you an idea of the plan's quality and performance. Plans with higher star ratings may offer better quality of care.

6. Enrollment Periods

In addition to the Annual Enrollment Period, there are other enrollment periods available in certain circumstances that can be utilized. For example, there is the Open Enrollment Period (OEP) that runs from January -March. This is for Medicare Advantage members who made a plan change but that plan isn’t working for them. Maybe they were enrolled by a call center and didn’t realize until they went to the doctor and were told their doctor doesn’t accept that insurance. There are also special enrollment periods throughout the year if you are diagnosed with a chronic condition, if you move, if you go to a skilled nursing facility, etc.

In conclusion, reviewing and updating your Medicare health plan is essential to ensure that you have the most suitable coverage for your healthcare needs and budget. Be sure to do your research, compare plans, and seek assistance if needed to make informed decisions.

Overview of Key Upcoming Dates:

●        9/30 – Annual Notice of Change and Evidence of Coverage sent from health plan provider

●        10/15 to 12/7 – Open Enrollment Date

●        1/1 – Your new Medicare plan goes into effect

What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant)1. Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage)1.

Depending on your eligibility and preferences, you can choose how to get your Medicare coverage. You can enroll in Original Medicare, which includes Part A and Part B, and pay for services as you get them. You can also add a separate drug plan (Part D) or a supplemental insurance policy (Medigap) to help pay for some of the costs that Original Medicare does not cover. Alternatively, you can enroll in a Medicare Advantage plan, which is offered by private companies that contract with Medicare. Medicare Advantage plans provide all the benefits of Part A and Part B, and usually include extra benefits such as prescription drug coverage, vision, dental, and hearing care1.

To qualify for Medicare, you must be a U.S. citizen or a legal resident who has lived in the U.S. for at least five years. You must also meet one of the following criteria2:

●        You are 65 or older and you or your spouse has worked and paid Medicare taxes for at least 10 years.

●        You are under 65 and you have a disability that qualifies you for Social Security or Railroad Retirement Board benefits for at least 24 months.

●        You have end-stage renal disease or amyotrophic lateral sclerosis (ALS), regardless of your age.

To enroll in Medicare, you can apply online at the Social Security website, call Social Security at 1-800-772-1213, or visit your local Social Security office. You can also contact the Railroad Retirement Board if you worked for a railroad. If you are already receiving Social Security or Railroad Retirement Board benefits, you will be automatically enrolled in Part A and Part B when you turn 65 or become eligible due to disability2.

We hope that this information helps you understand what Medicare is and how it works. If you have any more questions, feel free to give us a call or reach out to Kelly Perkins, co-author of this article and a Medicare Health Plan Specialist. You can reach Kelly by phone at (657)799-6484, email her at kpkinsurance@gmail.com, or visit her website at shineoninsurance.com. To schedule a free consultation with her you can do so using this link: Request a Consultation (shineoninsurance.com).