October 15 marks the beginning of the Annual Enrollment Period (AEP) for Medicare beneficiaries. It continues through December 7. This is the time to review your Medicare coverage to determine if any changes should be made for 2023. A Medicare beneficiary is required to have Medicare Part A & Part B plus a Prescription Drug Plan unless you have other “creditable coverage”. Failure to have those plans can result in a Late Enrollment Penalty when you enroll at a future date. Most people choose additional benefits like a Medicare Supplement or Medicare Advantage plan to provide broader coverage and lower their risk for medical bills.
If you are eligible for Medicare and have health benefits from an employer, you can keep the employer benefits for as long as you or your spouse are actively employed AND the employer plan meets the “creditable coverage” test of Medicare. You can switch from the employer plan to Medicare at any time. It is not dependent on when you leave employment. For most people, it is based on a comparison of costs and benefits. We are happy to help you evaluate your options.
The most common question we receive is “What are the differences between a Medicare Supplement Plan and a Medicare Advantage Plan”?
|Description||Medicare Supplement Plan||Medicare Advantage Plan|
|2022 Premiums||Monthly premium is based on age. Increases annually. >$80 per month.||Same premium for everyone. $0 -$26 per month for most plans.|
|Provider Network||No network. Eligible for any doctor that accepts Medicare.||Network-based. Can be HMO, HMO-POS, or PPO.|
|2022 Medical Out-of-Pocket Expenses||Plan G = Premium + $233 deductible.||Premium + copays for medical services. $0 – $4500 for many plans.|
|Travel Benefits||Can use any doctor that accepts Medicare anywhere in the US. Very limited benefits internationally.||Emergency services are always in-network. Need to use network providers for other services. PPO plans offer out-of-network benefits and may offer a national network. Very limited benefits internationally.|
|Prior Authorization Requirements||Based on Medicare guidelines.||Based on insurance company guidelines.|
|Ancillary Benefits||None.||Most plans offer vision, dental, hearing, fitness programs, over-the-counter medications & more.|
|Enrollment Eligibility||Open enrollment for 6 months following Part A & B enrollment or throughout a Trial Period for a Medicare Advantage Plan. All other applications subject to underwriting approval.||Open enrollment for 4 months following Part A & B enrollment. Annual enrollment period each year. Never subject to underwriting approval.|
|Renewal||Automatically renews. Not included in Annual Enrollment Period.||Automatically renews. Included in Annual Enrollment Period.|
Our ComPro Team will help you to identify the expected costs and benefits of each plan so that you can make a well-informed decision about your Medicare insurance. Please give us a call at 402.488.5100 to schedule an appointment to talk with one of our licensed health insurance agents or visit our website at comproins.com.
By Chris McPike – Individual & Senior Benefits Manager, Agent