What Boomers Need To Know About Annual Enrollment "Season"

The AEP (Annual Enrollment Period) or "Season" as some providers of these plans humerously suggest (as if on a hunt of some kind), is nearly upon us again. The period which runs from October 15 to December 7 is a good time for seniors on these limited and restrictive plans to assess their current coverage, access to quality care, out of pocket costs, disappointments, surprises etc and shop around for other plans which might better serve them and meet their needs. Their plan might not even be offered in 2013...hence the need for an "annual enrollment period." Before I go further, it's important to note that "AEP" (Annual Enrollment Period) does not apply in any way to folks who have Medicare as their primary carrier along with a traditional or modernized medicare supplement. Folks on Medicare don't have to enroll annually. Folks with a supplement to medicare don't have to enroll annually. The AEP only pertains to those seniors who enrolled in a Medicare Advantage Plan mandating that they stay in a network of providers who agree to the compensation the MA carrier offers them. In Illinois, the penetration of such plans is approximately 9%.  With Medicare and a supplement, coverage automatically renews each time you pay your premium. You NEVER need to reapply, unless you leave Medicare to join one of these MA Plans. Approximately 75% of retirees have either retiree insurance or medigap (supplemental) insurance. The other 25%, nationally, have enrolled in MA Plans...most are in what we call HMOs...with provider network limitations and restrictions. If you travel alot or want to keep/chose your current doctors/providers, original Medicare & a quality supplement would be the better choice. If you don't mind having a limited network of doctors and perhaps save some premium dollars (by staying healthy) then consider an MA plan. Some of these plans have little if any premium and if you remain healthy great. If not, several of these plans have considerable maximum out of pocket costs per year, which could easily exceed what a supplemental premium would have been. Co-pays for the first few days in the hospital can add up in a hurry with MA plans, along with skilled nursing co-pays and out of network costs etc. On the plus side, MA plans will include out patient drug coverage. Whether you want a Stand Alone Part D drug plan in addition to your supplement (approx $40 per month) or, you wish to join an MA plan which includes out patient drugs, Medicare can enroll you directly over the phone between October 15 and December 7 by calling them at 1-800-633-4227. This AEP is the time you use to make any changes in your drug program or your MA plan. As for supplements, you can change whenever you care to. YOU control that. If you are unhappy, contact your agent. You can change plans and/or carriers whenever you like. You will be asked health questions in most cases. A supplement is a "no-brainer." With MA plans, you have a much more complicated process. Are your doctors and hospitals in network? How does the doctor feel about the plan? A cheaper premium may be attractive (and if you stay healthy, great) but if you have high co-pays, deductibles and co-insurance, or less coverage, you realize, too late, the enormous financial risks. Lastly, if you have one of the MA Plans that advertise "premium free" that might come back to bite you in 2014 when the new tax will be implemented on those who pay no insurance premiums. This issue should be addressed long before then. In the meantime, be safe, keep smiling and you all know where to reach me on any of these issues we boomers must deal with, be it medicare, long term care or life insurance, we all are in this together. Some folks need help while others are just fine. Until next time then....

                                              Glenn Posner, CLTC