QUESTION: What do I do if I don’t want to change my insurance coverage in 2021?
The Medicare Annual Open Enrollment Period is well underway and we are hearing this type of question from individuals. The 2021 year has many more insurance plans available, but that doesn’t mean you have to or should change your coverage. When evaluating your options, I understand the decision to stay where you are as long as it will continue to work for you in the coming year.
The medicare.gov website is a very useful tool in this evaluation process. If you have set up and use your login and password to access the site, the information is tailored to your current coverage and how it works in the coming year. When reviewing that information, you may decide that there is not any better coverage out there, with regard to pricing and the pharmacies you use. In this situation, you can just leave your insurance alone and not move to an alternate plan. This decision to stay in the plan you are in requires no action from you. The plan you are currently enrolled into rolls over into the New Year and there is no action necessary from you. You do not need to contact the plan to inform them, you should not re-enroll into the plan you are already in. This is true for Medicare Supplement Plans, Stand Alone Part D Plans (prescription drug coverage) and for Medicare Advantage Plans of all types.
Those with Medicare are encouraged to evaluate their coverage options each year, so that they have the best possible coverage for the coming year. An individual’s health situation changes year to year, the medications can be different, your doctors may be different and the plans offer different coverage each year. So this annual evaluation is important to be sure you are doing the best you can do for the next calendar year. This evaluation process needs to include a brief review of each of those factors, as well as considering how well your plan did during this year. Are you happy with the coverage, the customer service and the pricing structures? If the answers are yes to those questions, and your medications will be covered in the New Year in a similar fashion then you can decide to stay where you are.
I do want to say that one of the big changes we are seeing this year is the change in pharmacy status. A number of the plans are changing how pharmacies are included in their coverage. The move from Preferred to Standard contract with Part D coverage and your pharmacy can make a significant change in the cost of your medications. In 2021 we are noticing that the again this year those contracts are changing. Those pharmacies that are included as preferred offer a significant savings to the enrollee when compared to the standard contract. A client and I reviewed their coverage yesterday, their current pharmacy was preferred and their medication was $0 co-pay during the deductible and initial coverage. The alternative pharmacy that they were thinking of trying moved was a standard contract where those co-pays moved to $21 each. That is a big difference in cost. This can also happen even when you don’t change pharmacies. Your plan may change the contract and the pharmacy you have always used is now a standard contract in 2021 instead of the preferred contract you are currently seeing.
In the situation where you have decided to stay with your current insurance coverage, you can let it roll. It is also important to remember there is still time to do that evaluation if you haven’t done it yet. The Annual Open Enrollment Period runs until December 7, each year. There are also other Enrollment Periods and Special Enrollment Periods available if your situation changes as the year 2021 progresses.
Here is to a wonderful 2021!
Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions, concerns or to reach Janell Sluga, GCMC, call us at 716-720-9797 or e-mail at SLM@lutheran-jamestown.org
