It Ain’t Over ‘Til It’s Over – The Final Days of Open Enrollment

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That great intuitive saying was muttered by the underappreciated, hall of fame baseball player Yogi Berra as he sought to communicate the unique aspect of baseball that allowed a baseball team to score multiple runs as long as they didn’t make the third out in the ninth inning. Unfortunately, the same can’t be said for the opportunity to change Medicare programs… after December the 7th the open season for choosing a Medicare plan will be over.

I’m sure you’ve noticed that the number and tenor of the insurance ads during this open season have both been dialed down. That has been the result of new rules instigated by the Centers for Medicare and Medicaid Services (CMS). The rules stipulated that the Medicare logo couldn’t be used so people weren’t confused that the ad was sanctioned by, or supported by, Medicare. They also made sure that the brokers were clear about which plans they are selling, and which beneficiaries were eligible for which benefits. For many of us, toning down the ads was a welcome change. But I have to admit, those ads helped me at least realize that there were options available that might benefit me, and they encouraged me to do some research before the open season is over.

So, here it is, Monday, December 4th, with the last day for changing your coverage only three days away: Thursday, December 7th. I’d like to conjecture that most of you have already done your research and made your decision on whether to keep the plan you have or make a change, but I have a feeling that saying “most of you” may not be accurate. I only have to look at myself for proof, since I haven’t finished my research yet. I started over a month ago but got busy. Thank goodness for this blog because it has refocused me, and now I’m actively finishing up my fact gathering. One thing that was helpful was the periodic emails I would get from Medicare indicating that I had started my review but hadn’t finished.

I thought it might encourage you to do some research in the next three days if I told you about my experience with my plan this year. I won’t tell you which plan I have, as I’m not here to promote any plan. What I will describe is my experience, which I’m glad to report was very positive. Hopefully it will expand your knowledge of what’s available. I will tell you that I’m enrolled in a Medicare Advantage plan. I’ve revealed that fact in earlier blogs. I do want to point out that there are down sides to some Medicare Advantage plans. They use in-network providers, which may not be your preferred providers, and there could be extra charges if you go to out-of-network providers. There may be higher co-pays for some specialists and procedures, and there could be prior authorization required for some treatments. As it is with almost every major purchase or decision we make in life, there are pros and cons. Information is the key to deciding what is best for you personally.

With my plan, I pay no premium. I was unhappy with my former primary care doctor and searched within the in-network doctors and found one within a mile from my home, and he has worked out fine. I paid a $180 co-pay for an MRI and a $20 co-pay to see an orthopedic doctor. My prescription drugs have had a zero co-pay. I was taking three drugs and now take two. I have a zero-cost membership to a community swimming pool and exercise facility. I had a root canal and crown, which cost $100 copay. When the bill was submitted by the dentist, my plan paid the entire bill. The dentist even sent me a check for the $100 co-pay. I get a yearly $500 credit card that will pay for co-pays and other charges that my plan doesn’t pay. This card can be used for any hearing, eye, and dental charges. I get $15 dollars a month for over-the-counter items.

That’s my 2023 experience and I’m happy with the plan choice I made this year. I haven’t had any operations or hospital stays, so I can’t tell you about how that would work out. I am eligible for a knee replacement, but my knee hasn’t given me any real pain yet, so I will put it off until it becomes a problem. It is, however, something for me to consider as I evaluate other plans since it looks like a knee replacement is in my future. That is one thing you need to do, take your best guess on what your future health problems might be as you make your decision. Don’t forget to consider those maladies that are common within your family and ancestors.

I’ve included my experience to give you a real-life example of one person’s participation in a Medicare plan. Hopefully, it will spark some interest and questions that will push you toward finding the answers you need to make the choice that is right for you. It is far too common that people underestimate the ability of older Americans to know what they want and to find ways to obtain the information needed for them to make the right decision for themselves. Making the right choice during the open season can often save you a considerable amount of money. You’ve got three days left, and then it will really be over.

Best, Thair

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