It’s that time of the year.  Open enrollment for Medicare.   From the 15th of October through 7 December. That’s true for folks who are already in the program.  But, trust me, the first time you sign up for Medicare, it’s just as confusing.’

Let’s start with the fact that there are so many flavors one can choose, beyond the basic Medicare coverage.  Then, there’s the plethora of advertising on TV that promises to make your decision a cinch- NOT!

In a nutshell, Medicare Part A is simply hospital insurance.  Medicare Part B is medical insurance.  The federal government takes the premiums for these two parts automatically from your Social security benefits.  If you don’t have Social Security, the government will make you pay these premiums in another way.

Medicare Part D covers your prescriptions.  It includes some discounts, but each of the vendors have different coverage amounts for you medicine- it takes a fair amount of research to discern which of these plans is best  for your personal needs.

Medicare Part C is also called Medicare Advantage.  Private firms offer this coverage (and they are approved by Medicare).  It is important to check to see which of these really are managed care, which are HMO-bases, and which are PPOs.   So, you need to be sure that your docs and hospitals are part of the program.

Thankfully, Medicare has an online tool that is fairly good to help one make a choice.  You can also call Medicare (800.633.4227) for answers.  If you are still confused, find a RELIABLE consultant (not one affiliated with an insurance company) to help you navigate the system.

There’s also Medigap Insurance (aka Medicare Supplement Insurance).  This is also purchased from a private entity, that should cover the costs of out-of-pocket expenses (copays, co-insurance, and deductibles).  The out of pocket limit is $ 4835 (in network) and $ 8650 (out of network) services.

 

That chart above includes all the potential choices.  Except that many of them no longer exist.  (For example, I have Medicare Part F- a supplemental plan that truly covers my health needs.  (It includes Medicare Part A, B, C, and the options of F.   But, that plan variety is no longer offered.  I am thrilled I got my chance at the apple, though.)  There are 10-choices- A through D, F, G, and K through N.  Except, as I said, F isn’t available for those who qualified for Medicare are 1 January 2020 (nor is Plan C).

Here’s a fact that gets most of us ticked off.  WE can switch from Medicare Advantage back to the original Medicare during Open Enrollment (This year from 15 October to the end of the year).  Except, if you’ve been part of Medicare Advantage for longer than a year, you have lost guaranteed access to Medigap insurance.  Now, it depends on your medical history.

Each year, we need to check if we have the best choices for Medicare Advantage and Part D.  Not only for costs, which drugs will be covered and for how much.

There are also changes coming to the program.

The Inflation Reduction Act is one such change.  In 2024, if you have Medicare Part D and your drug costs meet or exceed the catastrophic range, your copayments and coinsurance are obviated.  Insulin costs are limited to $ 35 a month, with no deductible.  (This latter benefit began in mid 2023.)

You should also know that Part B premiums are somewhat income dependent.  Many of us will pay $ 174.70 (2024 rates); but if our adjusted gross income is high enough, you will pay that an an income related monthly adjusted amount (IRMAA).  (That threshold will be somewhere around $97K for singles and $ 194K for couples.)

For CY2025, there will be an annual cap for our out-of-pocket expenses of $ 2000 a year (Medicare Part D).

Issues to Avoid

Medigap Coverage

The original Medicare coverage left gaping holes in coverage.  And, if you don’t have Medigap coverage, you will have some significant out-of-pocket expenses.   When we first sign onto Medicare (around age 65), we have a six month window to add it to our portfolio- with no health questions.  After that, there are only a few special occasions that we can personally add Medigap coverage.  So be careful not to cancel this as you add or adjust your coverage.

Beware the HMO

Just like we found out with regular insurance, several Medicare policies use preferred vendors (limited networks) .   Call your doctors to enure that the plan you are about to join provides full access to the physician of your choice.

Drug Coverage

Whatever plan you choose, you need to verify that the drug regime you  employ is found in the codex of your plan.  That is how we ensure the we have chosen the right drug for our needs.

Caveat emptor!

Oh, yeah, we do offer consultation services to help you manipulate the shoals of the Medicare system.

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I recommend you obtain a copy of “One Bold Move a Day”, written by Shanna Hocking.  The book shares hard-won advice and insights gleaned from 20 years as a successful manager of large teams.  Shanna helps you choose concepts and methods to reach your goals every day of your personal life.  And, the key point- the time to start is now!

Among suggestions in the book is seeking out a mentor, even a personal board of advisors,   as well as these other recommendations- stop relying on external validation, stop trying to prove yourself, there is no such thing as perfect or a perfect time, celebrate the progress you make each and every day, and practicing gratitude.

I am asking you- my loyal readers- to provide me a short blurb of what you are doing to make yourself better each day, how you are helping to remove the bias against women and minorities in STEM and management, and the like.  (Use this form, please.) I will choose among those items submitted between today and the 1rst of November and provide you a copy of Shanna’s book, One Bold Move a Day.

Good luck!