Every year, Medicare provides an opportunity for beneficiaries to make changes to their health coverage. This period is known as the Medicare Open Enrollment or Annual Election Period or Fall Open Enrollment. The Open Enrollment runs from October 15 through December 7 each year. During this time, a Medicare beneficiary can add, drop, or change his/her Medicare Advantage and Part D plans. Even if a Medicare beneficiary is satisfied with his/her current health and drug coverage, Open Enrollment is a good time to review what a beneficiary has, compare it with other available plans for 2025, and make sure that the current coverage still meets his/her needs for the coming year.

Here are the changes a Medicare beneficiary can make during Open Enrollment. They include:

1. Switching to a new Medicare Advantage Plan
2. Switching to a new Part D prescription drug plan
3. Switching from Original Medicare to a Medicare Advantage Plan
4. Switching from a Medicare Advantage Plan to Original Medicare (with or without a Part D plan.) *

*Note: If a beneficiary switches to Original Medicare and wants to purchase a Medicare supplement plan (known as a Medigap policy) to supplement coverage, Medigap options may be limited or not available

based on a beneficiary’s health status.

Depending on where a beneficiary lives, he/she may be able to buy a Medigap policy, which helps pay some of the costs that Original Medicare does not pay for. Limitations apply as to who can buy a Medigap policy and when. Call your State Health Insurance Assistance Program in New Jersey (800-792-8820) to obtain the facts about enrolling in a Medigap plan.

The last change made during Open Enrollment will take effect on January 1, 2025. It is usually best to call 1-800-MEDICARE (633-4227) or go to www.Medicare.gov when making any changes to your health and/or drug coverage.

Regardless of how beneficiaries receive Medicare coverage, they should consider:

• Access to health care providers they want to see.
• Access to preferred pharmacies.
• Access to benefits and services needed.
• The total costs for insurance premiums, deductibles, and cost-sharing amounts.
• The quality of the customer service they will receive.

A great resource to assist beneficiaries with information on Medicare, is the 2025 Medicare & You handbook. Beneficiaries should review any increases to Original Medicare premiums, deductibles, and coinsurance charges. The Medicare & You handbook is mailed to all Medicare households each September. If beneficiaries do not receive the Medicare & You handbook, they can call 1-800-MEDICARE and request that a copy be sent to them, with information relevant to the area where they live. If a beneficiary would like to receive the handbook electronically, he/she can log into (or create) a Medicare account to sign up for the electric handbook. A version can also be downloaded at Medicare.gov.

If you have a Medicare Advantage Plan or a stand-alone Part D plan, read your plan’s Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC). Review these notices for any changes in: a) the plan’s costs, b) the plan’s benefits and coverage rules, or c) the plan’s formulary (list of drugs the plan covers). Make sure that all your drugs will still be covered next year and that your providers and pharmacies are still in the plan’s network. If a beneficiary is unhappy with any of the plan’s changes or the plan’s performance, a beneficiary can enroll in a new plan. For assistance reviewing plan options, contact the State Health Insurance Assistance Program (SHIP) for unbiased counseling.

Even if you are satisfied with your current Medicare coverage, remember that plans change every year. A beneficiary should consider other Medicare health and drug plan options in his/her area. Check to see if there is another plan in your area that will offer better health and/or drug coverage at a more affordable price. Research shows that people with Medicare prescription drug coverage could lower their costs by shopping among plans each year. There could be another Part D plan in your area that covers the drugs you take with fewer restrictions and/or lower prices.

Ask yourself the following questions before choosing a Part D drug plan:

• Does the plan cover all the medications I take?
• Does the plan have restrictions on my drugs (i.e. prior authorization, step therapy, or quantity limits)?

○ Prior Authorization means that you must get approval from your Part D plan before the plan will pay for the drug.

○ Step Therapy means that your plan requires you to try a cheaper version of the drug before it will cover the more expensive one.

○ Quantity Limits restrict the quantity of a drug you can get per prescription fill, such as 30 pills of Drug X per month.

• How much is the cost for monthly premiums and the annual deductible?
• How much is the cost at the pharmacy (copay/coinsurance) for each drug?
• Is the pharmacy the beneficiary uses in the plan’s preferred network? (A beneficiary pays the least if a preferred network pharmacy is used.)
• Can the prescriptions be filled by mail order?
• What is the plan’s star rating?

Medicare has a helpful tool to assist in comparing Medicare Advantage and Drug plans, known as the Medicare’s Plan Finder. This tool gives you a list of Medicare Advantage and Part D plans, the drugs they cover, and their estimated costs for the year. You can access the Plan Finder by going online at www.medicare.gov/plan-compare or by calling 1-800-MEDICARE.

Note that beginning in 2025, annual out-of-pocket Part D costs will be capped at $2,000. This includes what is paid for during the deductible period and as copays/coinsurance. After meeting the out-of-pocket limit, a beneficiary will pay $0 for covered Part D drugs for the rest of the year. This change should be reflected in the Plan Finder tool when a beneficiary compares Part D plans for 2025.

Also beginning in 2025, beneficiaries will have the option to sign up for a payment plan for the Part D out-of-pocket costs. This program is called the Medicare Prescription Payment Plan, or it may be referred to as “smoothing” costs. It lets the drug costs be spread out throughout the year. If you sign up, the Part D plan will send a monthly bill, and the beneficiary will pay $0 at the pharmacy. The payment plan does not reduce the out-of-pocket costs, but it can help people with high drug costs concentrated in the early months of the year manage their monthly expenses. To sign up for the payment plan, contact your Part D plan in 2025.

Charles Clarkson, Esq. is project director of Senior Medicare Patrol of NJ.