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Updated on 9/28/2023
Updated on 9/28/2023
Updated on 9/28/2023
Medicare Open Enrollment Time Frame
Medicare’s Open Enrollment Period (also called the Medicare Annual Election Period) is for those already on Medicare who want to enroll into or change from an existing Medicare Advantage or stand-alone drug plan for the upcoming year. It starts October 15th and runs until Dec. 7th. If you elect to make any plan changes during this time (i.e., submit an application for a new plan), the plan change will take effect as of January 1st. If you are turning 65 or are over age 65 and are new to Medicare Part B (for example, retiring from your job and losing employer sponsored health insurance) you are considered to be in you Initial Medicare Open Enrollment Period in which case different rules apply.
Changes For Next Year
Every year, usually around the 1st of October, Medicare Advantage and Medicare prescription drug plans send out notifications to each of its members detailing any changes for the upcoming year. These notifications are called the “Annual Notice of Changes” (“A.N.O.C.”). Changes generally include increases or decreases in cost sharing (i.e.: copays, deductibles and coinsurance), prescription drug costs and provider networks that may be added or dropped. It’s a good idea to read your A.N.O.C. letter from your plan to help you decide if you should keep your plan or start shopping around for a better deal.
How To Choose The Right Plan
If you considering changing Medicare Advantage plans or looking to try out a Medicare Advantage plan for the upcoming year, you’ll want to take a look at four important things: doctors, network, drugs and affordability. Below, we take a closer look at each of these factors and how they may impact your health care.
Doctors
The first step is to make sure that all of your doctors will be in-network for the plan you are considering. You do not want to find out the hard way that one or more of your most important doctors will not accept your plan or are not in the same network. The easiest and most accurate way to determine if a medical provider is in a plan network is to look up your doctor(s) on the plan’s online provider directory. From there you should be able to search by name, city, county, state and/or zip code.
Medicare Advantage HMO’s
If you are looking at HMO plans you will need to make sure that not only do your doctors and other providers accept the plan, but are also in the same network. Here’s an example: Let’s say you enroll in Best Medicare HMO plan. Your primary care doctor, who accepts Best Medicare HMO plan, is in the ABC medical group network. Your cardiologist, who also accepts Best Medicare HMO plan, is in the XYZ medical group network. In this scenario, your primary care doctor would not be able to refer you to your cardiologist and you may end up having to see a different cardiologist who is in the ABC medical group network instead. The lesson here is to make sure that both your primary care doctor and your cardiologist accept your Medicare HMO plan and are both in the same medical group network.
Medicare Advantage PPO’s
If you are considering a Medicare Advantage PPO, you can still see doctors who are out of network and be covered. However, you may be paying up to 50% of charges - which could make Medicare Advantage PPO plans unaffordable for some people. One thing worth noting is that many PPO plans have much higher annual out of pocket maximums (the most you could be responsible for in a given year) for out-of-network charges compared to in-network. A $11,300 out-of-network annual out of pocket maximum is fairly common (as a side note, Medicare Advantage HMO plans tend to have much lower out of pocket maximums).
Medicare Advantage Private Fee For Service plans (PFFS)
Another type of Medicare Advantage plan is called a “Private Fee For Service” plan. These plans are very different from Medicare Advantage HMO and PPO plans and are typically found in more rural, less populated areas. If you are considering one of these types of plans, you must be sure that your doctor(s) will agree to the plan’s terms and conditions.
Prescription Drugs
The next step is to make sure all of your medications are included in the plan’s formulary (a formulary is a list of drugs covered by the plan). All Medicare Advantage plans with prescription drug coverage and stand-alone prescription drug plans have formulary look-up tools to help you determine if your medications are covered. They will also tell you how much your out of pocket expenses will be for each drug. Not all plan formularies are created equal as plans are not required to cover all drugs out on the market. Medicare requires that plan formularies must cover at least two drugs in each therapeutic category and include both brand and generic drugs. However, outside of the Medicare minimum formulary requirements, plans can choose which drugs to cover. This is where we find the biggest discrepancies between drug coverage options.
Affordability
Last but not least, you will want to make sure that the plan’s cost sharing expenses do not leave you financially strapped (for example, the plan premium is too expensive or deductibles, copays and/or coinsurances are too high). One very important plan element to pay attention to is the annual out of pocket maximum (sometimes referred to as the plan's “Maximum Out of Pocket” or “M.O.O.P”). This is the most you could be responsible for in a given year. Once the annual out of pocket maximum is met, 100% of medical expenses are then paid for by the plan. Needless to say that this is why it is important to choose a plan that has a low annual out of pocket maximum.
Help With Finding The Right Plan
Most people find it very helpful to talk to a knowledgeable health insurance agent or broker who specializes in Medicare and is appointed and contracted with many insurance companies. Agents and brokers by law are not allowed to charge consumers for advice and/or help with health insurance matters. Your premiums will be the same no matter if you enroll directly through an insurance company or through an agent or broker (agent and broker compensation comes from the insurance companies for the business that they write). Plus a good agent or broker will also advocate on behalf of their Medicare clients on issues that may come up down the road.
Medicare Open Enrollment Time Frame
Medicare’s Open Enrollment Period (also called the Medicare Annual Election Period) is for those already on Medicare who want to enroll into or change from an existing Medicare Advantage or stand-alone drug plan for the upcoming year. It starts October 15th and runs until Dec. 7th. If you elect to make any plan changes during this time (i.e., submit an application for a new plan), the plan change will take effect as of January 1st. If you are turning 65 or are over age 65 and are new to Medicare Part B (for example, retiring from your job and losing employer sponsored health insurance) you are considered to be in you Initial Medicare Open Enrollment Period in which case different rules apply.
Changes For Next Year
Every year, usually around the 1st of October, Medicare Advantage and Medicare prescription drug plans send out notifications to each of its members detailing any changes for the upcoming year. These notifications are called the “Annual Notice of Changes” (“A.N.O.C.”). Changes generally include increases or decreases in cost sharing (i.e.: copays, deductibles and coinsurance), prescription drug costs and provider networks that may be added or dropped. It’s a good idea to read your A.N.O.C. letter from your plan to help you decide if you should keep your plan or start shopping around for a better deal.
How To Choose The Right Plan
If you considering changing Medicare Advantage plans or looking to try out a Medicare Advantage plan for the upcoming year, you’ll want to take a look at four important things: doctors, network, drugs and affordability. Below, we take a closer look at each of these factors and how they may impact your health care.
Doctors
The first step is to make sure that all of your doctors will be in-network for the plan you are considering. You do not want to find out the hard way that one or more of your most important doctors will not accept your plan or are not in the same network. The easiest and most accurate way to determine if a medical provider is in a plan network is to look up your doctor(s) on the plan’s online provider directory. From there you should be able to search by name, city, county, state and/or zip code.
Medicare Advantage HMO’s
If you are looking at HMO plans you will need to make sure that not only do your doctors and other providers accept the plan, but are also in the same network. Here’s an example: Let’s say you enroll in Best Medicare HMO plan. Your primary care doctor, who accepts Best Medicare HMO plan, is in the ABC medical group network. Your cardiologist, who also accepts Best Medicare HMO plan, is in the XYZ medical group network. In this scenario, your primary care doctor would not be able to refer you to your cardiologist and you may end up having to see a different cardiologist who is in the ABC medical group network instead. The lesson here is to make sure that both your primary care doctor and your cardiologist accept your Medicare HMO plan and are both in the same medical group network.
Medicare Advantage PPO’s
If you are considering a Medicare Advantage PPO, you can still see doctors who are out of network and be covered. However, you may be paying up to 50% of charges - which could make Medicare Advantage PPO plans unaffordable for some people. One thing worth noting is that many PPO plans have much higher annual out of pocket maximums (the most you could be responsible for in a given year) for out-of-network charges compared to in-network. A $11,300 out-of-network annual out of pocket maximum is fairly common (as a side note, Medicare Advantage HMO plans tend to have much lower out of pocket maximums).
Medicare Advantage Private Fee For Service plans (PFFS)
Another type of Medicare Advantage plan is called a “Private Fee For Service” plan. These plans are very different from Medicare Advantage HMO and PPO plans and are typically found in more rural, less populated areas. If you are considering one of these types of plans, you must be sure that your doctor(s) will agree to the plan’s terms and conditions.
Prescription Drugs
The next step is to make sure all of your medications are included in the plan’s formulary (a formulary is a list of drugs covered by the plan). All Medicare Advantage plans with prescription drug coverage and stand-alone prescription drug plans have formulary look-up tools to help you determine if your medications are covered. They will also tell you how much your out of pocket expenses will be for each drug. Not all plan formularies are created equal as plans are not required to cover all drugs out on the market. Medicare requires that plan formularies must cover at least two drugs in each therapeutic category and include both brand and generic drugs. However, outside of the Medicare minimum formulary requirements, plans can choose which drugs to cover. This is where we find the biggest discrepancies between drug coverage options.
Affordability
Last but not least, you will want to make sure that the plan’s cost sharing expenses do not leave you financially strapped (for example, the plan premium is too expensive or deductibles, copays and/or coinsurances are too high). One very important plan element to pay attention to is the annual out of pocket maximum (sometimes referred to as the plan's “Maximum Out of Pocket” or “M.O.O.P”). This is the most you could be responsible for in a given year. Once the annual out of pocket maximum is met, 100% of medical expenses are then paid for by the plan. Needless to say that this is why it is important to choose a plan that has a low annual out of pocket maximum.
Help With Finding The Right Plan
Most people find it very helpful to talk to a knowledgeable health insurance agent or broker who specializes in Medicare and is appointed and contracted with many insurance companies. Agents and brokers by law are not allowed to charge consumers for advice and/or help with health insurance matters. Your premiums will be the same no matter if you enroll directly through an insurance company or through an agent or broker (agent and broker compensation comes from the insurance companies for the business that they write). Plus a good agent or broker will also advocate on behalf of their Medicare clients on issues that may come up down the road.
Medicare Open Enrollment Time Frame
Medicare’s Open Enrollment Period (also called the Medicare Annual Election Period) is for those already on Medicare who want to enroll into or change from an existing Medicare Advantage or stand-alone drug plan for the upcoming year. It starts October 15th and runs until Dec. 7th. If you elect to make any plan changes during this time (i.e., submit an application for a new plan), the plan change will take effect as of January 1st. If you are turning 65 or are over age 65 and are new to Medicare Part B (for example, retiring from your job and losing employer sponsored health insurance) you are considered to be in you Initial Medicare Open Enrollment Period in which case different rules apply.
Changes For Next Year
Every year, usually around the 1st of October, Medicare Advantage and Medicare prescription drug plans send out notifications to each of its members detailing any changes for the upcoming year. These notifications are called the “Annual Notice of Changes” (“A.N.O.C.”). Changes generally include increases or decreases in cost sharing (i.e.: copays, deductibles and coinsurance), prescription drug costs and provider networks that may be added or dropped. It’s a good idea to read your A.N.O.C. letter from your plan to help you decide if you should keep your plan or start shopping around for a better deal.
How To Choose The Right Plan
If you considering changing Medicare Advantage plans or looking to try out a Medicare Advantage plan for the upcoming year, you’ll want to take a look at four important things: doctors, network, drugs and affordability. Below, we take a closer look at each of these factors and how they may impact your health care.
Doctors
The first step is to make sure that all of your doctors will be in-network for the plan you are considering. You do not want to find out the hard way that one or more of your most important doctors will not accept your plan or are not in the same network. The easiest and most accurate way to determine if a medical provider is in a plan network is to look up your doctor(s) on the plan’s online provider directory. From there you should be able to search by name, city, county, state and/or zip code.
Medicare Advantage HMO’s
If you are looking at HMO plans you will need to make sure that not only do your doctors and other providers accept the plan, but are also in the same network. Here’s an example: Let’s say you enroll in Best Medicare HMO plan. Your primary care doctor, who accepts Best Medicare HMO plan, is in the ABC medical group network. Your cardiologist, who also accepts Best Medicare HMO plan, is in the XYZ medical group network. In this scenario, your primary care doctor would not be able to refer you to your cardiologist and you may end up having to see a different cardiologist who is in the ABC medical group network instead. The lesson here is to make sure that both your primary care doctor and your cardiologist accept your Medicare HMO plan and are both in the same medical group network.
Medicare Advantage PPO’s
If you are considering a Medicare Advantage PPO, you can still see doctors who are out of network and be covered. However, you may be paying up to 50% of charges - which could make Medicare Advantage PPO plans unaffordable for some people. One thing worth noting is that many PPO plans have much higher annual out of pocket maximums (the most you could be responsible for in a given year) for out-of-network charges compared to in-network. A $11,300 out-of-network annual out of pocket maximum is fairly common (as a side note, Medicare Advantage HMO plans tend to have much lower out of pocket maximums).
Medicare Advantage Private Fee For Service plans (PFFS)
Another type of Medicare Advantage plan is called a “Private Fee For Service” plan. These plans are very different from Medicare Advantage HMO and PPO plans and are typically found in more rural, less populated areas. If you are considering one of these types of plans, you must be sure that your doctor(s) will agree to the plan’s terms and conditions.
Prescription Drugs
The next step is to make sure all of your medications are included in the plan’s formulary (a formulary is a list of drugs covered by the plan). All Medicare Advantage plans with prescription drug coverage and stand-alone prescription drug plans have formulary look-up tools to help you determine if your medications are covered. They will also tell you how much your out of pocket expenses will be for each drug. Not all plan formularies are created equal as plans are not required to cover all drugs out on the market. Medicare requires that plan formularies must cover at least two drugs in each therapeutic category and include both brand and generic drugs. However, outside of the Medicare minimum formulary requirements, plans can choose which drugs to cover. This is where we find the biggest discrepancies between drug coverage options.
Affordability
Last but not least, you will want to make sure that the plan’s cost sharing expenses do not leave you financially strapped (for example, the plan premium is too expensive or deductibles, copays and/or coinsurances are too high). One very important plan element to pay attention to is the annual out of pocket maximum (sometimes referred to as the plan's “Maximum Out of Pocket” or “M.O.O.P”). This is the most you could be responsible for in a given year. Once the annual out of pocket maximum is met, 100% of medical expenses are then paid for by the plan. Needless to say that this is why it is important to choose a plan that has a low annual out of pocket maximum.
Help With Finding The Right Plan
Most people find it very helpful to talk to a knowledgeable health insurance agent or broker who specializes in Medicare and is appointed and contracted with many insurance companies. Agents and brokers by law are not allowed to charge consumers for advice and/or help with health insurance matters. Your premiums will be the same no matter if you enroll directly through an insurance company or through an agent or broker (agent and broker compensation comes from the insurance companies for the business that they write). Plus a good agent or broker will also advocate on behalf of their Medicare clients on issues that may come up down the road.
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By using this site, you acknowledge that you have read and agree to the Terms of Service and Privacy Policy. Please read our privacy policy carefully to get a clear understanding of how we collect, use, protect or otherwise handle your Personally Identifiable Information in accordance with our website. MedicareOptions360.com is privately owned and operated by MedicareOptions360. Submission of your information constitutes permission for an agent to contact you with additional information about the cost and coverage details of health plans. Possible options include, but are not limited to Major Medical Plans, Short Term Plans, Dental Plans, Vision Plans, and more. Descriptions are for informational purposes only and subject to change. Insurance plans may not be available in all states. For a complete description, please call 1-877-888-6315 to determine eligibility and to request a copy of the applicable policy. MedicareOptions360.com is not affiliated with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Our company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability.
By using this site, you acknowledge that you have read and agree to the Terms of Service and Privacy Policy. Please read our privacy policy carefully to get a clear understanding of how we collect, use, protect or otherwise handle your Personally Identifiable Information in accordance with our website. MedicareOptions360.com is privately owned and operated by Alderette Insurance Agency, Inc. Submission of your information constitutes permission for an agent to contact you with additional information about the cost and coverage details of health plans. Possible options include, but are not limited to Major Medical Plans, Short Term Plans, Dental Plans, Vision Plans, and more. Descriptions are for informational purposes only and subject to change. Insurance plans may not be available in all states. For a complete description, please call 1-877-888-6315 to determine eligibility and to request a copy of the applicable policy. MedicareOptions360.com is not affiliated with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Our company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability.
© MedicareOptions360.com, a division of Alderette Insurance Agency, Inc.,
138 N Brand Blvd, Suite 200 Unit #270, Glendale, CA 91203
By using this site, you acknowledge that you have read and agree to the Terms of Service and Privacy Policy. Please read our privacy policy carefully to get a clear understanding of how we collect, use, protect or otherwise handle your Personally Identifiable Information in accordance with our website. MedicareOptions360.com is privately owned and operated by Alderette Insurance Agency, Inc. Submission of your information constitutes permission for an agent to contact you with additional information about the cost and coverage details of health plans. Possible options include, but are not limited to Major Medical Plans, Short Term Plans, Dental Plans, Vision Plans, and more. Descriptions are for informational purposes only and subject to change. Insurance plans may not be available in all states. For a complete description, please call 1-877-888-6315 to determine eligibility and to request a copy of the applicable policy. MedicareOptions360.com is not affiliated with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Our company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability.