Medicare open enrollment started this week and goes until Dec. 7. Medicare beneficiaries have a chance to review their plans and qualifying individuals are able to enroll during this period.
Adults 65 and older are eligible for Medicare, and younger adults with certain disabilities may qualify for coverage.
By reviewing existing plans and comparing them with new ones, users can make changes that could potentially save money. New plans will start Jan. 1, 2025. During open enrollment, beneficiaries can switch or drop their Medicare Advantage or prescription drug coverage.
Medicare has four parts. Medicare Part A is hospital insurance that covers inpatient services, such as hospital stays, hospice, nursing facilities, inpatient rehabilitation and home health care services.
Medicare Part B is medical insurance that covers outpatient hospital services and some medications and home health services. Medicare Advantage includes Medicare Part C, which is a private health care plan. Finally, Medicare Part D covers prescription drugs.
Medicare Supplement, or Medigap, is a supplemental plan that works with private insurance companies to cover the costs that Medicare does not.
While open enrollment lasts until Dec. 7, Susan Neff, the Pennsylvania Medicare Education and Decision Insight (PA MEDI) Director, suggests users start the process early to make the best decision.
“You do have until December 7 every year, but we always recommend getting [an] early jump on it, and you can take your time throughout the weeks of open enrollment, but the earlier you start researching this, the better,” she said.
It’s important for beneficiaries to take their time assessing different plans, especially given the high volume available.
According to Seth Hackenberg, PA MEDI’s northeast regional coordinator, there are nearly 50 plans available in the northeast region alone. Popular ones in Northeast Pennsylvania include: Geisinger Gold, Aetna, Freedom Blue and Highmark Blue Cross Blue Shield.
Hackenberg sees people in the region falling victim to insurance companies rushing them to file their changes. He encourages beneficiaries not to rush through the process.
“The most common thing that we're hearing [is] that people… get notice from one of the insurance providers saying they need to act right away, or there's some kind of penalty or something if they don't go with that specific provider,” Hackenberg said. “You have the entire period [of] enrollment to make changes, you don't have to make it within a week period, or a 24 hour period. You have until that end date in December.”
According to Neff, there is a common misconception that the plan with the cheapest premium is the most cost effective. To maximize savings, she suggests looking past the premium cost.
“The first thing to do is to look at the overall cost for the plan,” she said. “Most people focus on the premium because that's something that they know that they have to pay every month. So a lot of people look for the zero premium plans, which there are a few that are offered in Pennsylvania. However, those zero premium plans tend to have higher costs for other services, like their co-pays might be higher.”
She also suggested looking at total out-of-pocket costs, plans’ provider networks, supplemental benefits, prior authorization requirements and individual prescription costs to get the most cost effective plan. There are cost saving programs that can assist with prescription drug costs, such as the Pharmaceutical Assistance Contract for the Elderly, or PACE, which is offered through the state Department of Aging.
This year, beneficiaries should be aware of new changes heading into open enrollment.
“There's very important changes to Medicare in 2025 that include a new $2,000 out of pocket cap for prescription drugs,” Neff said. “There's also a new optional payment plan to spread out your drug costs. So it's either through your Part D plan that's a standalone plan, or a Medicare Advantage plan that offers prescription drug costs.”
Hackenberg is pleased with how many people are taking advantage of open enrollment.
“I'm hearing across the board from my local coordinators in the regions that they're seeing an increase this year over last year, as far as people taking advantage of it,” he said.
With awareness of open enrollment increasing, Neff knows that it can be confusing to beneficiaries and wants people to know that PA MEDI is there to help.
“Medicare itself is confusing. It can be very complicated… This is our big time of year, so we're staffed up and ready to go to assist everyone,” Neff said.
For open enrollment assistance, Neff suggests calling PA MEDI’s toll free helpline at 1-800-783-7067. The National Council on Aging also has a list of resources available. Lastly, Neff said medicare.gov has resources to assist beneficiaries including comparison tools and rundowns of different plans.
Hackenberg coordinates meetings for beneficiaries looking for help. While aging centers across the state are eager to assist people, he urged people to sign up early for meetings.
“If you're interested in the open enrollment, or you do have some questions, I definitely tell people to reach out as soon as you can, because I know a lot of regions are already filling up with appointment time,” he said.
