Ready to enroll during the Medicare Annual Enrollment Period (AEP), but not sure of the plan that's right for you? Use this checklist to help you decide.
Know your current coverage and what you want out of a new plan
In order to know what you want in a new plan, it's important to know what's not working for you with your current plan. Write down what your current plan is lacking. For instance, do you need prescription drug coverage (Medicare Part D)? Or vision and dental benefits? Are you looking for a plan that offers fitness programs in addition to health care coverage? Write down the coverage and benefits you want in your new plan. You can reference this list during enrollment to help you choose the best plan for your needs.
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Know what you can — and cannot —do during AEP
Before you make any decisions about changing your Medicare coverage, it's important to brush up on the facts of AEP to understand what you can and cannot do during this time, so you can plan for the changes you want. You can't, for example, enroll in a Medicare Advantage plan (Medicare Part C) if you don't already have Medicare Parts A and B (either through Original Medicare or through a Medicare Advantage plan). You can, however, enroll in a prescription drug plan (Part D) if you have Medicare Part A and/or B.
Check Star Ratings
Medicare Advantage plans and Part D plans are rated by the Centers for Medicare & Medicaid Services (CMS) on a scale of one to five stars, with five stars being the highest ranking a plan can receive. These ratings determine how well a plan performs in several different categories. So, along with looking for a plan that fits your needs, it's important to take plans' Star Ratings into account, too.
Talk to your doctor, family, friends, and neighbors
Your doctor knows the state of your health and what kind of care you might need in the future — like screenings and tests. So bring a list of questions to your next doctor appointment or give your doctor's office a call and have a conversation about your health. Based on that conversation, you'll know the health services you might need covered in the upcoming year. So you can be sure to pick a plan that will offer the coverage you need.
If you have family, friends, and neighbors who have gone through the AEP process already, you can ask them about their experience.
Calculate and compare the costs of plans
All Medicare Advantage plans and Part D plans have different premiums, deductibles, out-of-pocket costs, and copays associated with them. It's important to take these costs into account when choosing a plan to make sure the coverage will meet your health and financial needs. Write down what you feel comfortable spending on health care each month and for the whole year, then estimate what your costs will be per month and year for the plans you're interested in. You can compare the costs across different plans to find the one that works best for you.
Know the rules and restrictions associated with plans
The rules and restrictions for Medicare Advantage plans vary from plan to plan. Some plans require you to go to doctors and providers that are in the plan's network (HMO plans), while others allow you to go out of network for care but require you to pay higher out-of-pocket costs for these services (PPO plans). Part D plans and Medicare Advantage plans that offer prescription drug coverage have different formularies (a list of prescription drugs the plan will cover) across all plans, too. So it's important to understand the prescriptions and services your plan will and will not cover before you enroll. Otherwise, you risk spending a lot more money out of your own wallet for your medicines and care.
Enroll by December 7
AEP runs from October 15 to December 7. So be sure to complete this checklist and enroll in a plan before the December 7 deadline. Otherwise, you may be stuck with your current coverage for another year.
If you have any questions about a particular plan and what it offers, you can call the plan to learn more about its specific coverage. Once you enroll, your new coverage will start January 1 of the following year.
Rachel Quetti is a health care writer at Aetna with experience in senior wellness, Medicare, commercial health care, and consumer engagement. When Rachel isn't trying out new fitness classes, she is cooking up fun, (mostly) healthy recipes in the kitchen. Rachel lives in Watertown, Massachusetts and has a degree in journalism from the University of Massachusetts, Amherst.
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