Time to sign up for Medicare under Open Enrollment. Here’s what new in 2021

Medicare’s fall-enrollment period, which runs through Dec. 7, is a time for seniors to review their coverage and make changes for the coming year.

Whether you have traditional Medicare with a supplement to cover out-of-pocket costs plus a stand-alone drug plan, or a Medicare Advantage plan that wraps coverage together in one package, there are always small tweaks to plans that are worth reviewing.

Plans may change which brands of drugs are covered, or which doctors are in-network, and you don’t want to discover that next year when it’s too late to switch.

Wading through the many plan options and features that become available every year is confusing no matter how much you know about insurance — and the relentless advertising by eager Medicare Advantage plans makes it more so — but doing your research can pay off.

“It’s gotten more complicated to be a Medicare beneficiary,” said Juliette Cubanski, deputy director of the program on Medicare policy at the Kaiser Family Foundation. “Even if you’re interested in shopping around, the burden of making the switch can seem greater than the benefits of doing so, but certainly when it comes to drug coverage alone, it can save people money if they’re willing to shop around.”

This year, analysts say, people with Medicare should pay particular attention to:

Lower costs for insulin

Next year, there will be a change to how some plans will cover insulin.

Beginning in January, Part D prescription medication plans, which are purchased by people who have traditional Medicare, will be allowed — not required — to cap the monthly copay for insulin at $35. The rule does not apply to Medicare Advantage plans.

The change could be a money-saver for people who use insulin to treat Type 1 or Type 2 diabetes. Insulin costs for seniors who do not receive federal subsidies to help with medication expenses shot up 79% between 2007 and 2017, to $580 a year.

Paying $35 a month could reduce annual spending to about $420, according to an analysis by the Kaiser Family Foundation.

But it’s important to consider the total cost of a drug plan before making changes, Cubanski said. Plans allowed to participate in the insulin copay program are “enhanced” plans, which offer more generous benefits, but also typically have more costly monthly premiums.

If you take other medications, check that they are also covered by the plan. If they’re not, the amount saved on insulin could easily be consumed by other drug expenses.

Sarah Murdoch, a client services director for the Medicare Rights Center, said the New York-based consumer advocacy group is getting more calls about Medicare’s financial assistance programs during the pandemic.

Fall enrollment is a great time for everyone to check whether they are eligible for help — regardless of whether their income has been affected by the pandemic, she said.

Programs to help lower-income families

There are several Medicare Savings Programs that help cover premium, drug, and healthcare costs for people based on their income and assets.

The Qualified Medicare Beneficiary program, for instance, offers the highest level of assistance and is designed for individuals with a monthly income of no more than $1,084 and assets of no more than $7,860 in 2020.

The Specified Low-Income Medicare Beneficiary program is available to people who earn too much to be eligible for the QMB program and helps pay Part B premiums.

“A lot of people are eligible for this and don’t realize it,” Murdoch said. “Especially now, when people are going through various hardships, [these programs] can be really helpful.”

If you typically visit state aging offices or other enrollment support organizations for help reviewing coverage options, Medicare enrollment specialists say it’s a good idea to give yourself extra time this year.

Many of the in-person support services that seniors rely on are going virtual because of the pandemic.

“At this point, we are only doing virtual and phone assistance,” Natasha Alagarasan, a spokesperson for the New Jersey Department of Aging, said in an email.

“The offices are preparing with the proper safety protocols for when in-person appointments are deemed safe to resume.”

Compare different Medicare plans

Kathleen Sarmiento, a liaison in Miami-Dade with SHINE, the federally funded, volunteer-based program to help Medicare beneficiaries understand their coverage, tells people to go to Medicare.gov and use its Plan Finder tool to compare their options. You can also call 1-800-Medicare or call SHINE for free assistance.

“At SHINE we can do an insurance comparison, so that they know which one to enroll in,” Sarmiento told the Herald last month. “We have 49 Medicare Advantage plans in Miami alone.”

At the Center for Advocacy for the Rights and Interests of the Elderly (CARIE), fall enrollment is typically a busy time for in-person consultations with seniors.

This year, CARIE, which is affiliated with Pennsylvania’s APPRISE program, is emphasizing telephone and virtual appointments.

“We are trying to meet our consumers where they are, asking what technologies they have and what their comfort level is,” said Karen Chenoweth, who helps people review Medicare options.