Monday, November 29, 2021

Medicare Changes Ahead May Cost Your Clients

It’s the time of year to have a Medicare check-up with them, says this expert.

Just like it’s a good idea for your clients to have an annual check-up for their health, it’s prudent for them to have a yearly Medicare check-up to ensure that coverage will work when folks need it and not break the bank.

The best time of year for everyone in Medicare to have that check-up is in the fall during the Medicare Annual Enrollment Period (AEP). The AEP cycle started Friday, October 15, and ends Tuesday, December 7 for coverage that goes into effect on January 1, 2022.

The Medicare AEP is an opportunity for everyone on Medicare to reevaluate features of their Medicare Advantage, also known as Part C, and Medicare Part D, prescription drug coverage.

Of note, some Medicare Advantage and Part D plans are consolidating 2021 plans into different 2022 Medicare plans with potentially other, more expensive plan coverage and less effective coverage. In addition, specific 2021 Medicare Advantage and Part D plans are discontinued in 2022. As a result, Medicare beneficiaries presently in these plans will not have Medicare Advantage or Part D coverage as of January 1, 2022, unless they take action to enroll in new coverage.

“Your clients look to you as a source of guidance in so many aspects of their financial lives. Medicare and related healthcare expenses are no exception.”

Your clients look to you as a source of guidance in so many aspects of their financial lives. Medicare and related healthcare expenses are no exception. Your clients likely mention when their healthcare costs are increasing or they’re having a hard time getting the care they need. Many times your clients are the caregivers for their elder family members on Medicare. The burden of managing and paying for care falls partially or entirely on them.

Overspending is Rampant

Nearly all (90% to 95%) of beneficiaries overspend on Medicare. That’s a startling statistic. The most common reason beneficiaries overspend is they purchase Medicare Part C (Advantage) and Part D (prescription drug) plans that do not meet their individual healthcare needs.

People tend to buy based on premium and overlook the benefits they use. Couples often purchase the same plan when they would be better off with different insurance coverage. Individuals may not realize the total cost of their healthcare until the new plan year has started, and then it is too late to make a change. Adding to the complexity is that all of these plans vary down to the county and zip code level!

All plans announce new pricing and benefits every fall. However, cost increases may not be in the premium but in other out-of-pocket costs, such as increasing deductibles; medications in a higher, more expensive drug tier; and greater use of co-insurance, as opposed to co-payments.

I advise that your clients do a Medicare check-up if any of the following happened to themselves or those they care for this year.

If the answer is yes to any of these questions, then a Medicare check-up is in order. Now is the perfect time for clients and their caregivers to pull their information together to make the task more manageable when evaluating their current plan and comparing other options. Here is a checklist to help people get organized.

Just Like Holiday Shopping

Right about now, you might be thinking that the Medicare check-up can be challenging and time-consuming. While both can true, just like holiday shopping, it is easier to get organized and start early. The good news is that several sources of free assistance are available to consumers and their caregivers to assist as they sort and sift through options. That said, free support services become overwhelmed quickly. Therefore, the earlier folks contact them, the more likely they will be available to assist.

Free Medicare Resources

Medicare (www.Medicare.gov) is the official US government site for Medicare.

  • 800-MEDICARE (800-633-4227) is answered 24 hours a day every day of the year by live customer service representatives who can conduct Medicare prescription drug plan reviews over the phone.
  • The site has a search engine to compare all Medicare Advantage and Part D plans available in every US county and zip code.
  • www.MyMedicare.gov is Medicare’s online portal for beneficiaries to manage many aspects of their coverage, including comparison shopping for 2022 at Medicare Advantage and Part D plans.

The State Health Insurance Assistance Program (SHIP)  (www.Shiphelp.org, 877-839-2675 national center) directs Medicare-eligible individuals and caregivers to free, local Medicare counseling and assistance throughout the United States. SHIP is a public service of the U.S. Administration for Community Living. The website and automated attendant can direct people to local SHIP offices 24 hours a day every day.

Social Security Administration (www.SocialSecurity.gov, 800-772-1213), Representatives are available by phone Monday through Friday, 8 AM – 7 PM.

Additionally, I recommend that advisors cultivate a referral relationship with well-established Medicare brokers. Those professionals can be very helpful to your clients and assist them with shopping for Medicare coverage.

If your clients are on Medicare or help someone who is, I encourage them to shop for Medicare Advantage (Medicare C) and Medicare D (prescription drug) plans this fall to ensure they get the best value for their money and have access to needed care.

Your clients do not want to be in the 90% to 95% of folks overspending on Medicare and wasting their hard-earned savings. Once the AEP window of opportunity closes on December 7, most Medicare enrollees will have to wait until 2023 to make Medicare coverage changes.

Dr. Katy Votava, PhD, RN, is the founder and president of GOODCARE.com, an online resource for planning and paying for healthcare. She has a Ph.D. in health economics and nursing. With her in-depth experience as a nurse practitioner and healthcare administrator, Dr. Katy is an expert in healthcare reimbursement and outcomes, including those related to Medicare, Medicaid, and long-term care. She is the author of the Amazon bestseller “Making the Most of Medicare: a Guide for Baby Boomers.”

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