How to Approach Medicare Open Enrollment: A Guide for Caregivers

Related topics: Caregiver Skills, Insurance, Financial Planning

Woman discusses Medicare options with her senior parents

It's that time of year! From October 15 until December 7, Medicare beneficiaries will be able to change their choices for Part D (prescription drug) coverage, enroll in or change a Medicare Advantage plan, and (in certain circumstances) possibly change Medigap plans.

Just writing that sentence gives one a knot in the stomach. Too many choices, not enough information. Where should you begin?

First, your care recipient should have received an annual notice from the companies that are supplying their coverage. Some of the packages look overwhelming and one just longs to discard them. But wait. At least take out the thinner booklet—the Annual Notice of Change (ANOC)—and look at the first few pages.

Infographic about why to evaluate Medicare plan

Is the plan premium going up? If so, is it going up a LOT? If the increase is 10% or higher, that indicates that there may be a better alternative out there.

What about the deductible? If it used to be zero, and now it's not, that's another indication that you may want to think about changes. The more difficult information to assess is changes in the drug premiums.

When you opened your packet, you saw the company had added another "tier" to the generic drugs. Your care recipient takes generic drugs. How will this affect them?

Is your loved one in a Part C/Medicare Advantage/Managed Care plan? Do you have any idea what you paid out in copays this year? Were there unexpected expenses that the plan did NOT pay? Are they likely to recur? You may want to consider changing to a Medigap plan with fixed costs.

Conversely, are you paying for a Medigap plan, but your loved one has few, if any, physician visits, except annual wellness checks and preventive benefits? If your relative lives in the same area year-round, you may want to investigate Medicare Advantage plans with lower premiums and possible additional benefits like hearing and vision assistance.

It is wise to assess these things each and every year. But if you haven't reassessed in at least three years, you need to think about having a "checkup." A number of options exist:

  • Use the Medicare Mini-Check tool to take advantage of the resources offered by the National Council on Aging. Fill out the four simple questions on this assessment and then see what next steps and resources are recommended for your particular Medicare situation. Through this tool, you can also access free professional advice about Open Enrollment from a licensed benefits advisor.
  • Find a State Health Assistance Insurance Program (SHIP) counselor in your region. SHIP provides free, federally funded one-on-one Medicare counseling. You can visit the SHIP website or call their toll-free number at 1-877-839-2675. However, be forewarned—it is often difficult to access this program during the Open Enrollment period. This is a particularly busy time of year for SHIP, so be patient with the office and be sure to call as early as October 1 for an appointment. You can also call your local Area Agency on Aging and ask if they are hosting any public information sessions about Open Enrollment that you can attend. This will provide you with a helpful intro to the topic, and you may even be able to ask questions publicly and privately.
  • Call 1-800-MEDICARE (1-800-633-4227), the Medicare program's toll-free number. You may have to wait. Try to call during "off hours." Once you get an advisor, make sure that they tell you what your loved one's "saved drug ID" and "password date" are so that you can use this information to do your own research on whether their drug formulary has changed.

Note: In most cases, you won't have a right under Federal law to switch Medigap policies unless you're eligible under a specific circumstance or guaranteed issue rights or you're within your 6-month Medigap Open Enrollment period. Your state may, however, have expanded these rights. Learn more or consult your state health insurance department to learn the rules in your area.

Source: Margie Johnson Ware, Aging and Health Specialist, for the National Council on Aging (NCOA). NCOA is a respected national leader and trusted partner to help people aged 60+ meet the challenges of aging. Its vision is a just and caring society in which each of us, as we age, lives with dignity, purpose, and security. And its goal is to improve the health and economic security of 10 million older adults by 2020.

Infographic courtesy of the National Council on Aging