Getting ready for Medicare Annual Enrollment Period (AEP)

Yes yes yes! It’s here, the season to compare, evaluate and decide on your Medicare Advantage or Prescription Drug Plan is right around the corner. So what should you expect? How should you prepare and how can you get the best out of this season?

What To Expect:

Yes I know I am a bit more excited about the Annual Enrollment Period (AEP) than your average person, and that’s just because I go on full throttle and get work done! Most of the year it’s pretty laid back for me but the fall comes with an avalanche of activity which includes shopping and comparing plans for our clients. As a Medicare insurance plan broker I have to help my clients make sure they are on the plan that best fits their needs. So it’s kind of a big deal…for me at least.

So we are now in the month of September, AEP is fast approaching. What should you expect to happen this month. Well it depends, if you are on a Medicare Advantage Plan or a Prescription Drug Plan you can expect something to come in the mail this month. If you don’t have a plan it’s time for you to get your ducks in a row for shopping season.

In the month of September, towards the end of the month Insurance companies will mail out the Annual Notice of Change (ANOC) letter to their Medicare Advantage and Prescription Drug Plan clients. In this document they will highlight the changes that are coming about for the upcoming year (effective January 1st). Remember these plans have an annual contract with Medicare, so they tend to make changes every year. Yes, sometimes the changes are minimal but sometimes they can be significant. Note that if you don’t currently have a Medicare Plan you can enroll during the AEP or other times of the year is you qualify.

Don’t know if you qualify? Just ask we can easily answer that question for you.

The ANOC letter will usually include information about changes to medical, drug and premium costs in your plan. These letter’s may be customized to you, meaning the company may include a list of the medications you take that may no longer be available in the list of covered medications (formulary) while others may just leave that up to you to compare. So make sure to read it carefully, take special note to what is changing as it can be mixed in with other benefits that are not changing. It’s a terrible feeling when you go to the pharmacy in January expecting to pay one thing for your medication to realize you may have to pay a lot more, so it’s best to do the homework and not get a surprise price hike! Please note that many companies will not mail you an updated formulary, you’ll need to request one from them. Specify that you want the upcoming year formulary.

Another thing that may be included for some: plan cancellation notices. What!? Yes, it’s possible that your plan may not be available in the county you live in the following year. It doesn’t happen that often but it does happen. If you get this notice, don’t get alarmed you’ll have ample opportunity to compare plans and choose one to be effective January 1st. Just make sure you follow the below preparing recommendations. Even if you forgot to make a plan election during the AEP season, you’ll get extra time to select a plan.

After you received your ANOC, what’s next? Next comes the release of plan information for all the insurance companies, that happens on October 1st. On that date all the plans benefits get added in the insurance company websites and also on the official Medicare website ( www.medicare.gov ) for all to see. Additionally, these insurance companies add into Medicare.gov their updated formularies (if their plan covers medications). This allows a consumer or their broker to enter their medications on the Plan Comparison tool in Medicare.gov and calculate an annual estimate of their medication costs. The site also allows you to select the pharmacy you use to fill your medications in order to get more exact pricing. This is important because some companies may have preferred pharmacy networks, meaning it could be cheaper to go to one pharmacy than another, sometimes the cost differences can be as much as double the price!

From October 1st until October 14th you cannot request a plan change, this period only allows you to compare plans. Starting on October 15th and until December 7th you are allowed to submit enrollment applications into a plan to be effective on January 1st. Of course, if you like your plan you don’t have to do anything, you don’t have to submit an enrollment application renewal as these plans renew automatically. Unless of course on the ANOC letter they told you otherwise but that’s only if the plan you had is no longer available for the following year as I already described above. If you submit multiple enrollment applications, the last application you submit will be the plan you are ultimately enrolled in for January 1st. So if you enrolled in one early on, you can still change your mind and enroll in another as long as you do it by December 7th.

So what now? Don’t be surprised on the massive amount of Marketing Materials you’ll get in the mail. Beware of these “You may not be getting all the Medicare Benefits you are entitled to” letters. They may look like they are from Medicare but in fact they are just marketing from an insurance agent trying to earn your business. While we generally want to be careful on marketing remember that some plans that are marketing are designed for a subset of Medicare beneficiaries. Say for examples those that qualify for a Special Needs Plan (SNP). This may require the person to have Medicaid (state co-pay or premium assistance) or a Chronic disease to be eligible to enroll.

If you gave a general idea of what to expect, you are now ready to prepare. Read on.

Preparing:

1. If you are in a Medicare Advantage Plan, pull together a list of the doctors that you see. Last name, first name and speciality would be ideal (e.g. Dr. Smith, John Cardiologist). This is important for a Medicare Advantage Plan as they all have networks, even if it’s a PPO plan that allows you to see providers out-of-network you’ll still want to see if they are in-network because it’ll save you money. Most PPO plans will charge you more if you go out-of-network, say a higher co-pay or co-insurance. So to make your life easier make a list that way you don’t leave a doctor out.
   • Common doctor specialities: Don’t forget all the specialities, some common ones are: Cardiologist, Neurologist, Orthopedic, Optometrist (eye check ups), Ophthalmologist (diseases of eye), Urologist, Gastroenterologist, Endocrinologist, Rheumatologist, Vascular Surgeon, Dermatologist, Gynecologist and Otolaryngologists or Ear Nose & Throat (ENT), Pulmonologist and Oncologist.
2. Update your list of medications. It’s important to compare plans by seeing how much your medications will cost or even if they are in the plans formulary. Every year these formularies can change, your medications can move from one tier to another and thus change how much you pay for them.
   • Brand vs. Generic – Note that many insurance companies may not cover the brand name of a medication and just cover the generic version. But what if I must take the brand name of a medication? Maybe the generic medications available give you a bad reaction. In those cases it may be possible to get a formulary exception from the insurance company to approve you to take a brand name if it’s not already in their list of covered drugs. This normally gets requested by your prescribing physician as they have to provide medical proof to the insurance company.
   • Here is an example of how to list your medications should look like.
     • Example: John’s medication list:
       1. Lisinopril 10mg tablet 1 a day
       2. Humalog Insulin Injection 10ml vial, 3 vials a month (you can also provide number of units a day)
       3. Levemir Insulin Pen – 3 pens a month
       4. Atorvastatin 20mg capsule 1 a day
   • By providing a month supply or a daily supply that can easily be calculated to monthly it allows you to get a better estimate when comparing plans.
   • As needed medication: Some medications you may take as needed, in those cases try to average your monthly use so as to get your projections cost estimates as close as possible.

Comparing Plans

Now that you have your list of medications and doctors it’s also important to factor in benefits that are most important to you. Say for example that every year you have to get a specific test, say an MRI. You’ll want to make sure to check the cost for such test on each of the plans that you are considering. In general for Medicare Advantage Plans you’ll want to make sure that all co-pays as a whole are competitively affordable. Other benefits to consider are the extras like Dental, Vision, Hearing Aid, Transportation and Over the Counter allowances just to name a few.

Checking the network: This is important because you’ll want to make sure that you can still see your doctors with the plan you selected. Also if you like a specific hospital you’ll also want to make sure that they are in-network too. Other things to consider on network is travel. All Medicare Advantage Plans will allow you to see providers nationwide for Urgent Care or Emergency services and that’s for both HMO’s and PPO plans. What becomes more important is if you’ll be traveling for long periods of time to a different state and you’ll want to have doctors in that area (ex. Snowbirds). HMO plans may have restrictions, they may not have network providers in the areas you travel to so it’s important to consider this before choosing a plan. If you’ll be traveling long periods it may be a good idea to have a PPO plan with a national network.

Star Ratings: Each year plans get a Medicare Star Rating 1 to 5. When plans are not performing to Medicare’s standard they may receive a below average rating, that would be anything below 3 stars. So what happens if a plan receives consecutive below average ratings? Their plan can be terminated and their members would have to switch to another plan. Generally if you have a plan with 3 stars and above you’ll be ok. Some plans may be too new for a rating, that happens when a new plan becomes available that hasn’t been offered in any other area by the company. This shouldn’t alarm you but make sure that you review the rating the following year just to see how they are doing.

Questions you should ask are:

• What would my co-pays be for the most used services? This can include the medications you take every month and doctor you see most often or tests you have every year.
• What would the costs be if I were hospitalized?
• What if I have to have cataract surgery, what would that cost me?
• Are there any extra benefits like Dental, Vision, Hearing and Fitness?
• How much does the plan cost a month? Note that having a premium on a plan doesn’t necessarily mean it gives you better co-pays or benefits, make sure to really take a good look at the summary of benefits.

There are many plans out there so make sure to get an early start on your comparison. Some shop for plans by visiting each insurance companies sales meetings to learn about the products. This generally is not a bad idea but given current health risks with Covid-19 many will probably skip these meetings this fall. Traditionally in these sales meetings you can only hear about one or two plans the company is offering in your county so it may not help you compare more than one plan, you’ll be going to a lot of meetings! But what is nice is that you are able to hear the questions of other attendees, sometimes they do ask questions you may have not thought of. Additionally you’ll likely not have the list of doctors and formulary to compare in these meetings.

Others compare plans by visiting the insurance companies websites and checking benefits one plan at a time, there are tools within many of the companies to help you narrow down the plan you want but in my opinion these online tools are ‘just ok’ at best. Personalize comparison take more time and effort, a real understanding of your needs. Plus you’ll probably need to visit a lot of the insurance companies websites and get a feel for each of their websites. In Atlanta there are at least 8 Advantage companies offering plans and each have multiple plans. If you are shopping for a drug plan there are even more.

Lastly others work with someone like me, a Medicare Insurance Broker. Brokers are contracted with multiple Medicare insurance companies and are able to do a lot of the work for you. Don’t confuse them with Insurance company Agents, they usually just work for one company and can only offer one company set of plans. If you like to see how I work for my clients give me a call, I’ll be happy to be interviewed for the position. Our services don’t have a fee because the insurance companies we are contracted with pay us commissions for the policies that we have in-force. Each company has a standard set of commissions they must follow to pay their agents, so one company to another you don’t have differences. This helps avoid agents enrolling clients into the “highest paying” plan. Even if that was possible that would just be short sighted as a brokers success is tied directly with providing their clients the plan the best fits their needs.

So there you have it, hopefully this article can help you be ready for the upcoming AEP season. We discussed what to expect, letters and updates from the insurance companies, including massive amounts of marketing. Next we talked about preparing for the season, meaning we got to get our lists together to allow us to shop. Lastly comes the comparing, where we make sure that we are selecting a plan the fits our needs best.

We hope you have a successful AEP and if you need our help don’t hesitate to contact us.