Things Medicare Beneficiaries Should Do After the Annual Election Period (AEP)
During the Medicare Annual Enrollment Period or AEP, you can change your Medicare coverage to adjust to your ever-changing coverage needs. You can change your Medicare Advantage (Part C) plan to a new Medicare Advantage plan, end your Medicare Advantage plan and reenroll in Original Medicare, and change your Medicare Part D Prescription Drug plan.
When the Annual Election Period (AEP) ends on December 7th, there are still some things Medicare beneficiaries should take the time to consider. Here are some key things Medicare beneficiaries should do after the end of the Annual Election Period (AEP).
Look Into Your Medicare Advantage (Part C) Plan and Decide if Changes are Needed
If you are one of the millions of Americans who enrolled in a Medicare Advantage Plan during Annual Election Period (AEP), and you conclude that it doesn’t fit all your needs, don’t worry! The Medicare Open Enrollment Period (OEP) begins on January 1st and ends March 31st. During Open Enrollment Period (OEP), beneficiaries can swap to a different Medicare Advantage Plan.
It is important during the Open Enrollment Period (OEP) that you review your plan’s costs & benefits for the upcoming year and ensure that your Medicare Advantage plan meets your medical and financial needs.
It is important that you review your plan’s out-of-pocket costs & check to see if your doctors accept your new Medicare Advantage Plan. If there are any issues or you feel that this plan will not meet your needs or budget for the upcoming year, it is a good idea to schedule an appointment with a licensed insurance agent, like the team at Seniorstar Insurance Group. An agent can help you find and enroll in a Medicare Advantage plan that meets your needs. After reviewing everything, if you decide you don’t want to be enrolled in a Medicare Advantage plan, you can switch back to Original Medicare and enroll in a standalone Medicare Part D Prescription Drug Plan during the Open Enrollment Period (OEP).
Review the costs of your Medicare Part D Prescription Drug Plan
Prescription drugs can become costly without the correct insurance plan to cover them. If you enrolled in a Medicare Part D Prescription Drug Plan during the Annual Enrollment Period, take the time to check the coverage to ensure all your medications are covered by your plan. If this isn’t the case, and you find holes in your coverage, you can sign up for a Medicare Advantage plan or a different Medicare Part D Prescription Drug Plan during the Open Enrollment Period. If you are someone who needs over-the-counter medications, it is important to note over-the-counter drugs aren’t covered by Medicare Part D Prescription Drug Plans or Original Medicare. However, some Medicare Advantage plans offer over-the-counter benefits.
Filing Appeals
Filing an appeal with the help of your agent can also be a good way to mitigate unwanted drug costs but be sure to check with your provider to see if an alternative drug might fit better with your coverage.
If you do choose to file an appeal, there are a few things you should know. First, you should get a coverage determination document from your Medicare Part D Prescription Drug Plan. This document will allow you to see if a certain drug is covered, the costs associated with the drug, the qualifying factors you must meet to get the drug, and if your plan will make an exception. If your doctor decides to give you a drug that isn’t on your plan’s formulary or an alternative drug doesn’t work in place of the drug you think you need, ask for an exception from your Medicare Part D Prescription Drug Plan. Once you ask for the exception, your Medicare Part D Prescription Drug Plan will make a decision on the exception. When you view this decision, if you don’t agree with it, you can then file an appeal with Medicare.
There are five different places your appeal can reach once you file. The first is your Medicare Part D Prescription Drug Plan. They will look at your appeal again and send another decision. If you disagree with this second decision, you can send the appeal to a third party. Then, the Office of Medicare Hearings and Appeals will handle all disagreements with third-party issued decisions and deliver their own decision. If this decision is inadequate for you, or they don’t respond quickly, you are able to send the appeal up to the Medicare Appeals Council. They will review the appeal and make a final decision unless your appeal meets a high enough dollar threshold, in which case this appeal will be sent to the Federal district court for judicial review.
Review Medicare Supplement Plans
If you were deciding on coverage with a licensed agent during the Medicare Annual Election Period (AEP), they may have suggested a Medicare Supplement plan that can help you cover the costs of Original Medicare. You cannot have both a Medicare Advantage plan and a Medicare Supplement simultaneously, so you must choose between the two. However, after the AEP, during the Open Enrollment Period (OEP), you can choose to cancel your Medicare Advantage Plan and return to Original Medicare and enroll in a Medicare Supplement. Whether or not this is a good option for you depends on the costs associated with each plan, such as copays or doctors not accepting your plan. Medicare Supplements are more equipped to cover things related to out-of-pocket costs associated with Original Medicare, such as copays & coinsurance but sometimes have a higher premium or underwriting. In general, Medicare Advantage plans can be a good option for those with fixed incomes or needing a lower monthly premium. It is important that you learn more about your Medicare Advantage plan after the Annual Election Period (AEP) so you know if you need to review or change anything.
In addition to ensuring your Medicare coverage will meet your needs in the new year, after the Annual Election Period (AEP) can be a great time to review additional insurance products such as life insurance, final expense, or ancillary products. If you are interested in learning more about your options, or more about how to know if your Medicare plan meets your needs, contact Seniorstar Insurance Group today at 732 658 5100.
