Sixty-Five Incorporated

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What is Medicare-Question
Why do I have to pay attention to Open Enrollment? I am happy with my current Medicare plan.

Answer to What is Medicare question
You are happy with the plan you have today.... But the Part D drug plan or Medicare Advantage plan you have today is NOT the same plan you'll have in the next calendar year.

Each January 1st marks the start of a new plan year. 

A new plan year means insurance companies can – and often do – make changes to their plans that can cost you. If you're not paying attention and simply let your plan renew, these are changes you’ll have to live with for better or worse in new year.  

Here are some important things that insurance companies can change in your coverage. For Part D plans:

  • the monthly premium.
  • the annual deductible.
  • your out-of-pocket co-pays.
  • the drug formulary (listing of medications the plan covers). Just one medication leaving your plan's formulary can cost thousands over the course the year.
  • the network of pharmacies.
  • the pharmacy cost-sharing.
  • coverage rules for medications (quantity limit, step therapy, prior authorization)
  • coverage of medications in the Coverage Gap, commonly known as the Medicare donut hole.  Increasingly, plans are dropping this type of coverage.

For Medicare Advantage health plans:

  • the monthly premium. Medicare Advantage plans may or may not have a premium.
  • your out-of-pocket co-pays and coinsurances.
  • the annual out-of-pocket spending limit. Each year these limits continue to creep up. Is your plan's limit going up?
  • the network of providers. 
  • coverage rules (plan limits, referral, and prior authorization requirements).
  • extra benefits, such as. routine dental and vision care, transportation, in-home support services. 

Prior to the Open Enrollment Period, your Medicare Advantage or drug plan must send information about changes in benefits and costs for the upcoming calendar year. Take time to study that information. You can make changes anytime between October 15 and December 7.

If you have concerns about your coverage, you can use the Medicare Plan Finder to compare plans. Or, if you prefer to have an unbiased Medicare expert review your coverage and ensure you're making the most cost-effective choices, 65 Incorporated offers a Medicare Tune-Up™ service


Last updated: 09-21-2022