Fred L. Goldenberg: Medicare options still available for 2023

Stephanie Shomin, The Record-Eagle, Traverse City, Mich.
·4 min read

Mar. 20—In the last few weeks, I've had numerous inquiries and consultations with people seeing if they could still make changes to their 2023 Medicare programs. All felt they had made a mistake last year and were under the impression that once they made their choice during last year's Annual Enrollment Period (AEP), they were stuck until next year.

Happily, I was able to inform them that in actuality there are several opportunities available for Medicare beneficiaries who either knowingly or unknowingly made the wrong choice when picking their 2023 plan. It all depends on whether they have a Medigap or Medicare Advantage plan that will determine what path to take.

For many the biggest issue was complacence. These individuals were happy with their plan, so they didn't think they needed to review their coverage for 2023. Only to find out now that there are new options ("what you don't have an over-the-counter card?") and lower costs ("seriously, you're still paying a monthly premium?") available that they would like to have. The other issue I've had to deal with this year is those who believed everything some washed up athlete or actor told them on TV, and they dialed the 800 number, switched plans and now are finding out that their doctor isn't in network, or their prescription isn't in the formulary.

In either case, they aren't happy and want to change. The good news is they can. From Jan. 1 through March 31 we are in the Medicare Advantage Open Enrollment Period (OEP). The Center for Medicare Medicaid Services (CMS) added the OEP for just the reasons I outlined above. I call it my "do over" option. Like when we were kids and we didn't like the outcome of some game and we'd yell "do over," only this has far greater impact on our lives. You have a one-time option of changing plans or even going back to original Medicare and stand-alone prescription coverage. Use caution if going back to original Medicare as a Medigap supplement might need to be medically underwritten before you can qualify.

Right now, you might be thinking, "Thanks, Fred. I have less than two weeks to make these changes or I have to stay where I am for the rest of the year." What else have you got?

Well, the next rabbit I pull out of my hat will make both Medigap and Medicare Advantage users happy. Let's start with those on Medigap.

One game many health insurance providers play is they send out premium increases on Medigap policies mid-year. I've already had a few calls from disgruntled Medigap users complaining that they have already gotten their premium increase. As Medigap premium continues to go up, based on utilization and attained age, the monthly outlay can become oppressive. Mid-year increases ensure that the insurance company has at least six months of higher premium before you can switch plans.

So, let's say they raise premiums by 8-10% this year. In your mind you're kind of stuck paying that premium until the AEP so you can change it for Jan. 1, 2024. Yes, you can change your Medigap policy anytime, but you may find that you will be medically underwritten, and coverage could be declined or rated. But what you may not know is that there is a way of switching from Medigap to Medicare Advantage mid-year without any underwriting. Even after the OEP.

The following is from CMS and pertains to both Medigap and Medicare Advantage plans: "If a Medicare Advantage Plan, Medicare drug plan, or Medicare Cost Plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period to switch from your current Medicare plan to a Medicare plan with a '5-star' quality rating. You can use this Special Enrollment Period only once between Dec. 8 and Nov. 30 the following year."

Obviously I'm informing you of these options because they are both available in our area. You have until March 31 to use the OEP option and if you miss it, you still have the "5-star" plan to fall back on for the rest of the year.

Fred L. Goldenberg is a Certified Senior Advisor (CSA) and the owner of Senior Benefit Solutions, LLC, a financial services and certified health insurance organization affiliated with Michigan Planners in Traverse City. With any questions or comments about this column or interest in monthly Medicare classes, please call 231-922-1010 or email fred@srbenefitsolutions.com.