Medicare open enrollment runs from Oct. 15 to Dec. 7. Next year, the cap on out-of-pocket prescription drug costs rises from $2,100 to $2,400, and the deductible goes from $615 to $700. Because insurers change their drug lists, premiums and contracted pharmacies every year, even a plan that renews automatically may look different. Any changes take effect Jan. 1.
From Oct. 15 to Dec. 7, Medicare enrollees can change their plans. The window comes only once a year, and the choices made during it take effect Jan. 1 of next year.
There are four things you can do during this period. You can switch from Original Medicare to Medicare Advantage (Part C), or go back from Advantage to Original Medicare. You can also switch your Advantage plan to one offered by a different company. You can also join a prescription drug plan (Part D), move to a different one, or drop coverage altogether.
Numbers Changing Next Year
Drug costs get a bit heavier than this year. The cap on out-of-pocket prescription drug costs rises from $2,100 to $2,400. That means once you have spent $2,400 on drugs in a year, you pay nothing more out of pocket. The cap remains a solid protection, but you now have to spend $300 more to reach it.
The deductible also rises, from $615 to $700. That means you pay the full cost of drugs yourself up to the first $700, and insurance applies after that. Both figures are already set by federal rules, so they apply the same whether or not you change plans.
The Part B premium and deductible are still projections. The Medicare trustees report put the premium at $209.50 per month. The official amounts will come out in November, so keep in mind that you will not know them yet when you choose a plan.
The Mistake of Assuming Nothing Changes If You Do Nothing
If you do nothing, your current plan renews automatically. The problem is that the "same plan" does not necessarily have the same terms next year. Insurers adjust premiums, out-of-pocket costs, covered drug lists, and contracted hospitals and pharmacies every year.
Two things happen most often. One is when a drug you take is dropped from the formulary or moved to a higher tier, causing your costs to jump. The other is when your primary care doctor or specialist leaves the network. If you only find out at the pharmacy counter in January, there is little you can do to undo it.
The Annual Notice of Change (ANOC) your insurer sends between September and October lists everything that will change next year. It arrives in a thick envelope in English and is easy to leave unopened, but checking just two things, the premium and the drug list, will catch nearly all of the important changes.
What to Check When Comparing Plans
When comparing plans, don't look only at the monthly premium. It is more accurate to enter the name of each drug you take. If you enter your drug names, dosages and the pharmacy you use most often into the plan finder on the official Medicare website, it calculates your total cost for the year. A plan with a cheaper premium often ends up costing more once drug costs are added.
If your income is below a certain level, you can apply for Extra Help, which greatly reduces prescription drug premiums and cost-sharing. People who receive both Medicare and Medicaid have additional separate opportunities to change plans.
If you find it hard to decide on your own, you can get free counseling. State governments run counseling programs, called HIICAP in New York and SHIP in New Jersey. They are not insurance sellers but neutral sources of explanation, and county offices for the aging can connect you. Some Korean American organizations and churches also offer counseling in Korean during this period.
If you miss Dec. 7, the next opportunity, for Advantage enrollees only, runs from Jan. 1 to March 31. During that time, you can only switch your Advantage plan once or return to Original Medicare. Your options become narrower, so it is better to finish by Dec. 7 if possible.