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Do's and Don'ts during Medicare Open Enrollment

With a myriad of choices, and window that's open only a few weeks to make them, the annual Medicare Open Enrollment period begins Oct 15. Those new to the program, as well as seniors who have been enrolled for some time, need to pay special attention to a few do's and don'ts when making those selections.

"Be aware of the deadlines," said Karen Munger, a licensed insurance agent and owner of Karen Munger Insurance Services, a Visalia insurance agency that specializes in working with health insurance plans for seniors. "Once the open enrollment period closes Dec 7, with very little exception, you will be locked in with whatever plan you have at that point, whether it is still the right plan for you or not."

For those just turning age 65, or those younger but with qualifying disabilities, open enrollment can be a confusing maze of decisions. There are several options available to seniors, whether to enroll in traditional Medicare either with or without purchasing an additional supplement, or instead select one of the Medicare Advantage plans, each having different features and benefits that can be selected based on the individual needs of the enrollee.

Anyone new to Medicare and those already enrolled are advised to seek the advice and counsel from a licensed, insurance professional when considering options. There are also resources available online at And the Kings Tulare Agency on Aging also offers free Medicare counseling through the HICAP program.

Munger recommended four things to do and four things to avoid for new or existing Medicare enrollees while navigating through open enrollment.

1. Never be pressured to do anything immediately

"Have a family member with you at any meeting to help review the plans," she said. "You don't have to make a decision that day."

2. Review your ANOC carefully

"Everyone in an existing Medicare plan (other than those in Medicare supplement plans) will receive this form," Munger said about the Annual Notice of Change form that comes in the mail. The form provides information about changes to rates and co-payment, along with any changes to the plan. Be aware of any changes in premium costs or out of pocket charges to your existing plan.

3. Look to see if medications are still on the formulary

"You want to make sure the drugs you need are still covered by the plan," she said.

4. Use preferred pharmacies

"There is a network of pharmacies for each plan. Some plans will single out one or two pharmacies in which special pricing applies. These are called preferred pharmacies. Those pharmacies will often times offer the lowest pricing for medications," Munger said, adding that some seniors may continue to use a pharmacy out of habit. "Loyalty doesn't always pocket well," she said. "Don't assume that because your plan worked this year that it will be the same and work well the next year. Changes happen, premiums and co-payments can go up, drugs can come off formularies."

In addition to these suggestions, Munger also recommended the following things not to do:

1. Don't wait until the last week of open enrollment

It's an important decision, too important to make a mistake. Putting it off until the final week can result in a mistake, either in your rushing to make a decision, or by an insurance agent buried in last-minute work.

2. Don't compare your plan to someone else's plan

"Don't base your decision on a plan based on your friend's selected plan. Everyone has different prescription needs. What is a great plan for your neighbor may not be great for you. One size does not fit all," she said.

3. Don't shop by premium price alone

"You might pay more with a lower premium plan because your co-payments are higher," she said, adding the majority of phone calls she receives from Medicare clients during open enrollment are centered around their Part D prescription plan choices.

4. Don't use non-network pharmacies

Munger recommends making sure you know what pharmacies are approved by your plan. "Some people make assumptions and end up paying more because the pharmacy isn't a part of the approved network," she said.

The bottom line is whether you are new to Medicare, or if you've been enrolled for years, it pays to start the review process early, and carefully consider the options available. And having a trusted friend, family member or licensed insurance agent review those choices can help ensure you make the best selections.


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