Did you know that your Medicare plan automatically renews on January 1st?
Medicare’s Annual Enrollment Period (AEP) is a chance to change coverage every year, taking place from October 15th to December 7th — so it’s coming up soon. As an advertising agency that specializes in Medicare marketing for people over 55, THE 3RD EYE understands how important this period is for seniors to make informed choices.
It’s your opportunity to join, drop, or switch plans—from Medicare Original to Medicare Advantage, or vice versa—and even switch to a different Medicare drug plan if you’re in Original Medicare. If you didn’t enroll in a Medicare Advantage or prescription drug plan during your Initial Enrollment Period, the AEP is typically your chance to make these changes, unless you qualify for a Special Election Period (SEP).
Because of this, it’s key that Medicare users take the time to review their coverage before renewal.
More than ever, older adults should be and are focusing on their health and wellness. With increasing life spans and dropping birth rates, one in five Americans are expected to be 65+ by 2030, according to the US Census Bureau.
From mental health concerns that disproportionately affect seniors such as grief and loneliness to the cost of sedentary behavior for older adults, there are certain health concerns that should be a focus for seniors and their health care providers. Each individual has their own set of concerns depending on their medical history and lifestyle. As you review your current coverage, consider overarching medical needs and more narrow concerns affecting your health specifically. AEP is about ensuring your coverage matches your needs.
Trends in Senior Healthcare
In 2024, healthcare for older adults means much more than it did a few decades ago. With longer life spans has come more interest in embracing the phase of life that begins at 65.
“About three out of four older adults rate their health as good or excellent, showing that the stereotype of frail old age no longer holds true for everyone.” CVS Health Trends Report
We’re also facing an increase in longevity overall, with the population of individuals aged 85 and older projected to almost double by 2035, increasing from 6.5 million to 11.8 million, and expected to nearly triple by 2060, reaching 19 million. US Census Bureau
Many seniors are proactively taking charge of their health with technology, however. A new AARP survey, for instance, revealed that 55% of adults 50+ use health and wellness apps to track their fitness and physical activity.
When it comes to mental health, we’ve learned that while decline in aging and mental health don’t go hand in hand (older Americans actually tend to be happier than their younger peers), there are mental health concerns that older populations should be tending to.
“39% of providers have a high level of concern about the mental health of their patients over 65.2 In fact, other research shows that about 20% of retirement-age Americans have been diagnosed with a mental health condition” (CVS Health Trends Report).
Health Care Insights by CVS Health also revealed that many patients over 65 can be resistant to discussing possible treatments for mental health concerns with their health care teams.
Older adults encounter distinct mental health challenges such as grief and loss as a significant role in their emotional experiences — they retire from their careers, and may lose spouses and friends. Managing chronic health issues can also present psychological difficulties, alongside factors like medication effects, isolation, and loneliness.
When serving seniors, health and wellness brands should both take these key factors in mind and become familiar with medicare coverage to see how we can provide care that fits into it.
Quick Medicare Breakdown
Medicare is a federal health insurance program for people aged 65 and older, as well as those under 65 with long-term disabilities. It covers services like hospital stays, doctor visits, prescription drugs, and post-acute care, including skilled nursing, home health, and hospice care.
Beneficiaries can choose between traditional Medicare or a Medicare Advantage plan, with options for prescription drug coverage and supplemental insurance to reduce out-of-pocket expenses. Each year, during the annual open enrollment period, Medicare recipients can adjust their coverage choices to better meet their needs.
What is Medicare Open Enrollment?
The Medicare Annual Enrollment Period (AEP), also called the Medicare Open Enrollment Period, begins on October 15th and ends on December 7th every year. Medicare health and drug plans can make changes each year — things like cost, coverage, and which providers and pharmacies are in their networks.
Though beneficiaries are encourage to review their plans yearly and make changes according to updates, a KFF analysis of people with Medicare found that “only one-third (32%) compared their Medicare coverage options during a recent open enrollment period.”
EOC and ANOC
You can learn whether you should change plans by reviewing materials sent to you, specifically your Evidence of Coverage (EOC) and Annual Notice of Change (ANOC). You’ll receive them in September, so keep a look out.
IEP vs AEP
You may be asking: What’s the difference between the Medicare Annual Enrollment Period and the Medicare Initial Enrollment Period?
The Initial Enrollment Period is when you first become eligible for Medicare and can enroll in the plan that best suits you. The Annual Enrollment Period, on the other hand, takes place each year and allows you to join, switch, or drop plans. There are a few special circumstances where you can switch plans outside of this period, like if you are moving out of your plan’s coverage area.
What Changes Can I Make During AEP?
You can make the following changes to your Medicare Coverage during the Medicare Annual Enrollment Period:
- Switching from Medicare Advantage back to Original Medicare
- Transitioning from Original Medicare to a Medicare Advantage plan
- Selecting a different Medicare Advantage plan
- Choosing a new Medicare Part D prescription drug plan
- Adding a Part D prescription drug plan if you currently don’t have one
- Canceling your existing Part D prescription drug plan
Any changes made during AEP go into effect on January 1st of the following year.
Let’s say you have a Medicare Advantage plan but want to include Medicare Part D for prescription drug coverage, you can switch your plan during the annual enrollment period. The changes you make will take effect the next year.
Or, for instance, you adjusted your Medicare plan last year but are dissatisfied with your current coverage because it doesn’t meet your healthcare needs.In that situation, you can either drop your current Medicare plan entirely or make further adjustments to resolve any issues.
Traditional Medicare vs. Medicare Advantage
Traditional Medicare and Medicare Advantage both cover Medicare Part A and Part B services (listed below), but differ in costs, provider networks, and extra benefits.
– Medicare Part A: hospital insurance. There’s no premium cost if you’ve paid payroll taxes for at least 10 years.
– Medicare Part B: medical insurance. It requires you to pay premiums, copays and deductibles, like private insurance companies.
When choosing between them, think about factors like health needs, finances, care preferences, and provider access. Key considerations include premiums, deductibles, extra benefits, and rules on prior authorization and referrals.
Traditional Medicare offers broad access to doctors and hospitals without referrals, minimal prior authorization, and allows choice of stand-alone drug plans.
Medicare Advantage provides extra benefits like dental and vision, caps out-of-pocket costs, and bundles medical, drug, and supplemental coverage into one plan, often with reduced cost-sharing.
(Source: medicare.gov)
How do Medicare Advantage Plans Vary
Medicare Advantage plans vary widely in premiums, out-of-pocket costs, provider networks, extra benefits, and prescription drug coverage. In 2023, beneficiaries could choose from an average of 43 plans, with many enrollees paying no additional premium beyond the Part B cost.
Out-of-pocket expenses differ by plan, with hospital co-pays ranging from $195 to $450 per day. Each plan includes a cap on out-of-pocket spending, averaging $4,835 for in-network services. Provider networks and pharmacy access also vary, with some plans requiring higher cost-sharing for out-of-network care.
(Source: kff.org)
What To Keep In Mind When Making Changes To Your Medicare Plan
Go through this checklist of concerns and think of which applies to your life and needs. It will help you consider how coverage changes might affect you and which updates you should make.
Health Changes You’re Experiencing
Changing your Medicare plan can be helpful if your health situation changes. You may have pre-existing conditions that get worse or develop new chronic illnesses over time. If that’s the case, it might be a good idea to switch to a Medicare plan that provides better coverage and tailored care management programs for your condition. This ensures you have access to the treatments, medications, and support needed to manage your health effectively.
Specialist Care Needs
If you need specialized care from specific healthcare providers or specialists, switching your Medicare plan can help make sure those providers are part of your network. This enables you to access the specialized treatment you require without extra out-of-pocket expenses or limitations on your choice of providers.
Expanded Healthcare Services
As your healthcare needs change, you may need services that aren’t included in your current plan. Changing your Medicare coverage allows you to explore plans that provide more extensive benefits — such as dental, vision, hearing, or wellness programs, which can enhance your overall health and well-being.
Hospital or Facility Preferences
If you prefer the care provided at a particular hospital, clinic, or healthcare facility that isn’t covered by your current plan, switching to another Medicare plan can grant you access to receiving care from your preferred providers without additional costs or care restrictions.
Conclusion
The Medicare Annual Enrollment Period (AEP) is an essential time for beneficiaries to review their coverage and make adjustments that better suit their evolving healthcare needs. With the wide variety of plan options available, including differences in costs, provider networks, and extra benefits, it’s crucial to take the time to assess whether your current plan still meets your needs.
Whether you’re managing chronic conditions, seeking specialized care, or looking for enhanced benefits like dental and vision, the AEP offers a valuable opportunity to ensure your Medicare plan is the best fit. Don’t miss the chance to make informed decisions about your healthcare and prepare for the year ahead.
In The Third Eye, we’re experts at AEP. If you need help explaining the ins and outs of how to navigate Medicare’s Annual Enrollment Period to patients or healthcare consumers, email us here.