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Dear Carol: I’ve recently begun working with my mom on her medical care and financial management. Though she’s happy with her Medicare coverage, she says that during open enrollment we need to check things over. I’m not clear about the differences between plain Medicare where she has a Plan F Medigap policy, Medicare D, and Medicare Advantage. I’ve searched open enrollment, but I'm hoping that you can clarify. What do we need to do? – KJ
Dear KJ: Most adult children face some confusion about their parents’ Medicare coverage. While I need to stress that I’m not a Medicare or insurance expert, I’m happy to share some resources regarding open enrollment.
Open enrollment
- Fall open enrollment occurs this year from Oct. 15 through Dec. 7. Changes will take effect on Jan. 1, 2023.
- In most cases, fall open enrollment is the only time you can choose a new Medicare Advantage or Medicare Part D (drug) plan.
- Original Medicare (like your mom’s) requires a Part D drug plan. This is the plan you should keep a close eye on since changes in medications are common and coverage and premiums can vary.
- Most Medicare Advantage plans have their own version of a prescription drug plan. People on Medicare Advantage should review their plan yearly as well.
- Use Medicare’s Plan Finder tool when looking for Part D and Medicare Advantage plans in your area. The Plan Finder tool compares plans based on the drugs you need, the pharmacy you visit, and your drug costs. https://www.medicare.gov/
- Check Medicare’s “Medicare & You” booklet for yearly updates on Original Medicare coverage. Her Plan F is a Medigap policy that needn’t concern you during open enrollment, but this is a good time to look at updates.
- To recap, during open enrollment, if you and your mom are dissatisfied with her Medicare D prescription drug plan, or for others using a Medicare Advantage plan, now is the time to make changes.
Tips:
- Make sure that you start on Medicare.gov . If you don’t begin there, you could find yourself on a look-alike link that may or may not be legitimate.
- If like your mom, people already have a Part D plan, or if they have a Medicare Advantage plan, the subscriber should receive an annual notice of changes (ANOC) and/or evidence of coverage (EOC) from the plan. Review these notices for changes in the plan’s costs, benefits, and/or rules for the upcoming year.
- If you prefer to start the process by phone, call 1-800-MEDICARE.
- For legitimate, free help, visit the website of your State Health Insurance Assistance Program.
KJ, since your mom is happy with her Original Medicare with additional Plan F coverage (Medigap), your current concern will be to check her medications against her Medicare D plan. If all is well, then you don’t have to do anything. Working with your mom now will make you better able to manage her yearly Medicare changes in the future.
