GET Ready!! Medicare’s Open Enrollment Period is Almost Here!

By SHIBA (Statewide Health Insurance Benefits Advisors)

If you are on Medicare or soon will be, this is the time to make decisions for 2025. Open enrollment for Medicare Advantage and drug plans begins October 15^th.  This is when you review and update your choices of plans for the coming year.  Why is this a critical time for you to look at your plans?

• If you have an Advantage or Part D drug plan as part of your Medicare coverage, there will likely be significant changes for 2025. Premiums can increase, and/or benefits can change.  You should have received the Annual Notices of Change (ANOC) from your current plan(s) by now.  This will include premium rate changes, what the plan covers, and benefits that remain the same.
• These plans are affected by the Inflation Reduction Act, which limits the out-of-pocket costs you can expect for your medications to no more than $2,000 during the year 2025. This limit is for drugs you get from a pharmacy. The result is that to cover these costs, plans are raising rates and/or reducing benefits covered by the plan(s). This may include greater preauthorization of some benefits.  Some plans are even ceasing to be available.
• Your ANOC should spell out all of the changes. It is important that you read it and KEEP it should questions arise about your coverage. With these changes, you should review what your needs are, then consider changing your coverage for next year. You can make an appointment with a SHIBA adviser to help you review your current benefits and determine what to do.  Changes must be made by December 7^th and will start January 1^st.  
• If you have a drug plan or Advantage plan with drugs in it, you will likely have a deductible that needs to be met before the plan pays anything. Also, many plans have copays that can mount up quickly.  A co-pay is the amount you pay for a drug in addition to the monthly premium. In 2025, you will be able to arrange to make payments to your drug company to spread out the costs of expensive drugs throughout the year, rather than having to meet them all in the first month(s). This will make getting their medications easier for folks with limited budgets.

Help is readily available to review plans and make needed changes from trained SHIBA volunteers.  SHIBA (State Health Insurance Benefit Advisers) is a free program offered by the Insurance Commissioner’s Office. They are unbiased and can advise you of your options so you can decide what is best for you. Appointments are available Monday through Saturday, during the day and early evening, face-to-face, by phone, and Zoom.  Face-to-face appointments are available in Langley (i.e., Bayview), Coupeville, and Oak Harbor.  Call 1-360-321-1600 for an appointment or more information.

By planning ahead and “shopping” for the best plan(s), you can save money on your medical care.

FYI: If you have a Supplement/Medigap plan along with your Medicare plans, you can change that plan and the company offering the plan at any time, effective the first day of the next month. There is no open enrollment period for Supplement/Medigap plans.

FYI2:  The $2000 limit Part D for medications does not affect any drugs you receive as part of Part B Medicare benefits.