The Best Way to Choose a Plan During Medicare Open Enrollment Season

Do work with an enrollment agent.

Don’t assume your coverage from last year makes sense for this year.

Keep the conversation focused on health insurance and away from life insurance.

Medicare open enrollment is here (October 15 – December 7), and POWWOW encourages clients aged 65+ to work with an enrollment agent to ensure existing coverage is still suitable. If necessary, click HERE to be refreshed on the many different components of Medicare and its associated costs.

POWWOW spoke with Stuart Millard, CFP®, CLTC from Senior Insurance Solutions, Inc. to discuss what to consider during Medicare open enrollment. Stu says, “Open enrollment is the time to reflect on the prior year and decide whether you’re comfortable remaining in the same insurance plan network that’s provided through a Medicare Advantage PPO or HMO plan or if you have a Medicare Supplement plan are aware of the new plan options.  It’s also the time to review what changes to your Part D plan will be made in the coming year.” From a financial standpoint, Stu says, “If you are currently on a Medicare Advantage plan tally up the co-pays, co-insurance, and deductibles paid throughout the year to see how the total cost compares to other options, such as a Medicare Supplement plan which can cover your medical expenses at 100% and give you total freedom of choice for doctors.” If you find you’ve spent more than expected, had issues receiving care that was deemed out-of-network or had a significant change in medications, there’s a chance that switching to a Medicare Supplement plan would be in your best interest. Stu describes this as the “peace of mind plan,” but they do often come with a higher monthly premium.

Apart from hospital and medical coverage, there is prescription coverage to consider if you’re medicating a chronic condition. It shouldn’t be assumed that a Part D plan that served you well last year is still your best option going forward. Between fluctuations in personal health along with formulary changes within the plan, it’s financially critical to review your selection annually. Stu says, “There will be some major changes to the Part D plans for 2025 which may affect those with Part D plans. Pay attention to the Annual Notice of Change letter your current Part D plan provider will be mailing out in late September which will outline any changes.”

Stu also points out two other considerations when choosing the correct Part D:

• Are you aware of your Part D plans’ preferred pharmacy network and whether it will change for the coming year?
• Has your Part D plan deductible increased, and if so, are any of your medications subject to it?

I can attest that his first point on preferred pharmacies is essential to consider if you have recently moved or plan on moving. For example, seniors transitioning to assisted living may find that their retirement community is in contract with a specific pharmacy to handle their “med management” program. Managing your care efficiently within your new community may become complicated or expensive if your plan doesn’t jive with their contracted offering. Sometimes the community itself even charges a fee for having to deal with a non-contract pharmacy.

Utilizing an independent agent, like Stu Millard, ensures you’ll be educated on your options to help you make the best choice for the coming year. Once you’ve decided, he completes the paperwork and remains available to you throughout the year to serve as your advocate if you ever have questions about claims, billing, and covered services. What’s better yet is this is a free service to seniors! Agents are compensated through the selected insurer, and there is no difference in cost to you had you chosen to self-enroll in the same plan. 

Another point to keep in mind is even non-exclusive brokers can’t compare all options because certain insurers only work directly with consumers, such as Blue Cross Blue Shield. If you’re partial to this plan you’ll need to work with them directly. With that said, it would be smart to compare pricing to what’s being offered by a broker. Here is where you can compare coverage for your zip code. 

For those interested in MassHealth programs or have a relationship with their local elder services program, this is the time to schedule an appointment with SHINE (Serving the Health Insurance Needs of Everyone). Meetings can be scheduled through your local senior center. While SHINE can also work with seniors choosing standard Medicare coverage, they are only able to serve as educators and are not able to complete paperwork.

Lastly, when meeting with anyone regarding your Medicare open enrollment options make sure the conversation stays on course. If you’re presented with unsolicited life insurance illustrations for yourself, or worse yet your grandkids, stop things right there. This engagement should be purely focused on YOU and YOUR HEALTH. Proceed with caution you choose to continue with the agent after redirection.