Medicare Open Enrollment

It's that time of year again. How do Life Care Planning Law Firms work to make Medicare Open Enrollment easier for their clients?

People 65 and older have an annual ritual: Medicare Open Enrollment. It’s the time each year when Medicare plan enrollees can reevaluate their coverage and make changes if they wish to do so. Medicare Open Enrollment begins on October 15 and ends on December 7, with changes to coverage effective on January 1 the following year.

What changes can Medicare beneficiaries make to their health coverage during Open Enrollment? They can switch Medicare Advantage plans, switch from Medicare Advantage back to Original Medicare or vice versa, join a Medicare Part D prescription drug plan, switch from one Part D plan to another, or drop Medicare Part D coverage entirely. However, the annual open enrollment does not apply to Medigap plans, which are only guaranteed-issue in most states during a beneficiary’s initial enrollment period and during limited special enrollment periods. And from January 1 to February 14 each year, people can disenroll from a Medicare Advantage plan and pick up a Part D plan.

Medicare Open Enrollment can be a major challenge for seniors. “It's hard because many who have Medicare coverage don't realize that they should be evaluating their healthcare selections every year,” said Alicia Kagan, a Medicare Specialist at Rothkoff Law Group, a Life Care Planning Law Firm with offices in southern New Jersey and southeastern Pennsylvania. “Seniors are bombarded with Medicare-related mailings and are often confused about what they need to do,” said Alicia. “They often leave it up to their spouse and kids to figure out, which can leave everyone feeling overwhelmed.”

Many Life Care Planning Law Firms employ people like Alicia who understand the ins and outs of Medicare and other public benefits. These professionals are skilled at helping seniors and their caregivers evaluate their healthcare options and make better choices. “Each October, the care coordinators at our firm identify clients who will have the option to change their coverage during the Medicare Open Enrollment process,” said Alicia. “The care coordinators contact each client and offer to set up a phone call with me.”

During the call, Alicia reviews their current coverage, discusses their overall situation, offers her thoughts about the changes that might makes sense, and talks about the pros and cons of those changes. She also looks at their medication lists and makes recommendations for changes to drug coverage. “Clients really appreciate having someone to help them figure out what’s best for them,” Alicia said. “I’m able to give unbiased guidance because I’m not an insurance broker. I’m not making any commissions based on what I recommend. My only loyalty is to the client.”

Open Enrollment isn’t the only time clients and their caregivers interact with Alicia. “I spend a lot of time looking at people’s coverage when things change, such as a move to an assisted living facility or a nursing home, or an adjustment in medications,” she noted. “When some clients move to a different facility, their prescription bills may go up. There may be issues with doctors not being in their Medicare Advantage Plan network. When people transition to Medicaid, I help them understand how Medicare and Medicaid coordinate, how we might need to tweak their current coverage, and what benefits they can get under the different Medicaid programs in Pennsylvania and New Jersey.”

Alicia stressed the importance of viewing Medicare Open Enrollment as an opportunity for an annual healthcare checkup. “It’s the time of year when you can take a look at your coverage to see if it makes sense to change,” she added. “Having someone knowledgeable to talk to makes everyone breathe easier.”