If you’re enrolled in Medicare or care for someone who is, healthcare coverage is probably on your mind. The Medicare Annual Enrollment Period (AEP), from Oct. 15 through Dec. 7, is your opportunity to make sure you have the healthcare and prescription drug coverage that is right for you in the year ahead.

AultCare’s PrimeTime Health Plan Sales Supervisor Trisha Witts has nearly 30 years of Medicare education experience. Here, she shares information about what to consider during AEP.

The Medicare AEP is the time of year when we see the largest number of people coming into our Canton office, wanting help in making informed healthcare decisions.

Medicare can be confusing. We take the time to understand your needs, empowering you with personalized support so that you leave with the knowledge you need to make decisions with confidence.

Here are the basics, depending on your starting point.

Situation 1: You’re enrolled in a Medicare Advantage (MA) or Part D prescription drug plan.

Your first task is to carefully review the Annual Notice of Change (ANOC), which you likely received from your plan within the past several weeks. This document explains next year’s changes to cost, coverage, dental or vision benefits, etc.

Note that you will not receive an ANOC if you have a Medicare supplement plan because AEP does not apply to this category of plan.

After your plan review, if you want to remain in the same plan, do nothing. You will automatically stay with your current plan(s) in 2027.

If you aren’t happy, you can:

• Disenroll from your MA plan and join another (with or without Part D coverage),

OR

• Disenroll from your MA plan and enroll in a stand-alone Part D plan to cover your medications – and switch back to Original Medicare. You could also opt for no prescription coverage, but that puts you in a potential bind in the future – more on that below.

Situation 2: You have Original Medicare with or without a Part D prescription drug plan.

During AEP, you can:

• Add a prescription drug plan (Part D) to your Original Medicare (Parts A and B).
  
  
• Keep Original Medicare only without Part D. Be aware that you could face late-enrollment penalties if you want to sign up later and do not have “creditable” or equal value drug coverage.
  
  
• Enroll in an MA Plan (Part C). This is a private insurance plan with a Medicare contract. It combines hospital (Part A), medical (Part B) and often drug coverage (Part D). It can also include benefits like dental, hearing, vision, gym membership and meals after an inpatient/observation stay.

What are the advantages and disadvantages of an MA plan vs. Original Medicare?

One of the advantages of an MA plan is the financial protection it can provide with an annual out-of-pocket maximum, unlike Original Medicare. This helps limit your copay and coinsurance responsibility if something catastrophic happens.

All MA plans are required to cover the same services as Original Medicare. However, an MA plan is usually more inclusive, having extra benefits such as dental, vision, hearing and prescription Part D.

With Original Medicare you have the advantage of being able to visit any doctor or hospital that accepts Medicare. However, with a Medicare Advantage plan you need to pay attention to how the plan is structured and whether your providers are in the network.

If you have an MA plan that is structured as an HMO (health maintenance organization) this typically means that you have to get your care and services within the plan’s network, except in certain situations such as emergencies. In an HMO/POS (point of service) plan, you may be able to get some nonemergency services out of network, though you may pay a higher cost.

How can I learn more?
You’re welcome to visit pthp.com or ask questions directly to one of our team members by calling 330-363-7407 or 800-577-5084 (TTY: 711), seven days a week from 8 a.m. to 8 p.m.

You can also tune in to Health Matters at 9 a.m. on Friday, Oct. 23, to hear me explain more about what to consider before AEP ends Dec. 7. Listen live on AM 1480 WHBC or click here to watch the YouTube livestream: https://www.youtube.com/@gomedshoprx/streams.

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