Nine Tips for Choosing a Health Plan During Open Enrollment Season

The Medicare landscape features complexity and a wide range of choices. With so much to consider, you’ll want to be informed about picking the right plan for your health needs and budget. There’s no better time to do that than during the Medicare Annual Enrollment Period (AEP), October 15 – December 7.

This is the time when you’ll have the opportunity to select or switch your health insurance plan. Taking stock of your current plan or exploring options if you’re new to Medicare is critical, as Medicare benefits tend to change each year. Premiums may increase or decrease; doctors can get rotated in and out of private networks; certain medications may be dropped or added from a provider’s list of covered drugs.

To help make sure you are receiving the most appropriate and comprehensive healthcare coverage for your unique situation, here are nine tips to consider when choosing a plan that may help lead to better health and cost savings in 2024.

1. Review your Annual Notice of Change (ANOC) early. Beneficiaries should receive an ANOC letter from their provider in September or early October alerting them to any changes in coverage, costs, and more that will be effective in January. Reviewing this early can help you decide whether the plan will continue to meet your needs in the next year. If you don’t get this critical document, contact your plan.

2. Understand your options. Whether selecting a plan for the first time or evaluating how well your current one meets your needs, take the time to understand and compare the benefits, services, and costs of each plan so you can find what will work best for you. Ensure you’re familiar with the difference between Original Medicare and Medicare Advantage.

3. Check your prescription benefits and know your priorities. Some good questions to ask yourself are: Do I need to take specific drugs, or are generics OK? Do I need expenses to be balanced throughout the year? What if I don’t have many drug costs now but want peace of mind to avoid future penalties? Knowing how to get the most out of your prescription benefits may help you manage costs. For example, check into lower-cost alternatives that may be available, like discounts, generics, and more. For those on Medicare: You may be surprised to learn Original Medicare doesn’t generally cover prescription drugs. Consider adding Part D or a Medicare Advantage plan with prescription drug coverage to help keep your medication costs in check.

4. Anticipate next year’s health expenses. If you expect a significant health event in the next year, such as surgery, compare the differences between plan designs, including out-of-pocket limits.

5. Understand your out-of-pocket costs. Each part of a Medicare plan may have its own monthly fee (a premium); you may have to pay a set amount before Medicare starts paying for your care (a deductible); you may have to pay a percentage of the cost of a medical visit or service (co-payment). Knowing these details in advance can help you choose the right plan and also help avoid sticker shock down the line.

6. Consider a plan with the convenience of virtual care. If you’re busy juggling family or work responsibilities, traveling, or prefer to connect with a doctor from the convenience of your home, consider choosing a plan that includes 24/7 virtual care. Medicare Part B (Medical Insurance) covers e-visits with your doctors and other providers. These visits are designed to be an easier, more affordable way to talk to doctors about common health issues using a smartphone, tablet, or computer.

7. Check for mental health coverage. Managing your mental health is an essential step in caring for your overall well-being. In addition to in-person care, you may now access a large virtual health network of therapists and psychiatrists with many plans.

8. Look into wellness programs. Many health plans now offer incentives that reward you for healthier actions, such as completing a health survey, exercising, or avoiding nicotine. Many Medicare Advantage plans also offer gym memberships and wellness programs for members at no additional cost.

9. Don’t forget about specialty benefits. Untreated dental, vision, and hearing problems can have negative physical and mental health consequences. So, it’s important to consider coverage when seeking benefits that may contribute to your overall well-being. You may be surprised that Original Medicare doesn’t cover most dental, vision, and hearing services. Though many Medicare Advantage plans do, the extent of that coverage varies.

For complete information on enrolling in Medicare plans, you can review the CMS website at www.medicare.gov or call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, seven days a week.

Dr. Mario Siervo is board-certified in family medicine, serves as the regional director for WellMed Florida, and practices at Optum Little Havana. He believes in treating patients as a “whole” instead of an organ system, which helps him provide effective care. Dr. Siervo received his medical degree from the Universidad Autonoma de Guadalajara and later completed his residency at Advent Health Orlando.