This edition of Health Matters with the Medicine Center Pharmacy features special guest Mike Novelli from Aultcare and Primetime Health Plan. Mike will be helping us learn more about Medicare’s Annual Enrollment Peroid for 2024.

Your Guide to Medicare’s Annual Enrollment Period (AEP) 2024: FAQs Answered

Medicare’s Annual Enrollment Period (AEP) is a critical time for millions of Medicare beneficiaries. It runs from October 15, 2024, to December 7, 2024. During this window, individuals can make changes to their Medicare plans for the upcoming year. Whether you’re new to Medicare or a long-time participant, it’s essential to understand how AEP works and what your options are. Below, we answer some of the most frequently asked questions to help guide you through this period.

1. What is the Medicare Annual Enrollment Period (AEP)?

The Medicare Annual Enrollment Period (AEP) is a set time each year when beneficiaries can make changes to their Medicare coverage. This includes Medicare Advantage (Part C) and Prescription Drug Plans (Part D). AEP is also referred to as the Medicare Fall Open Enrollment period.

2. Who can make changes during the Annual Enrollment Period?

Anyone who is already enrolled in Medicare Part A and Part B can make changes during AEP. This includes:

                  •               People looking to switch from Original Medicare to a Medicare Advantage plan.

                  •               Those already enrolled in Medicare Advantage who want to switch to a different plan or return to Original Medicare.

                  •               Anyone who wants to change, add, or drop their Part D Prescription Drug Plan.

3. What changes can I make during AEP?

During the AEP, you have several options:

                  •               Switch from Original Medicare (Part A and Part B) to a Medicare Advantage Plan (Part C).

                  •               Switch from one Medicare Advantage Plan to another (with or without drug coverage).

                  •               Drop a Medicare Advantage Plan and go back to Original Medicare.

                  •               Change your Medicare Part D Prescription Drug Plan.

                  •               Enroll in or drop a standalone Part D plan if you’re on Original Medicare.

These changes will take effect on January 1, 2025.

4. Can I change my Medigap (Medicare Supplement) plan during AEP?

Medigap plans are not part of the Annual Enrollment Period. You can apply for a Medigap policy any time of the year, but if you’re outside of your Medigap open enrollment period, you might be subject to medical underwriting, meaning insurers can deny coverage or charge higher premiums based on your health status.

5. What if I don’t want to make any changes?

If you’re happy with your current Medicare coverage and it still meets your healthcare and financial needs, you don’t have to do anything. Your plan will automatically renew for 2025. However, it’s a good idea to review your plan’s Annual Notice of Change (ANOC) to ensure there aren’t any changes to costs, coverage, or provider networks that could affect you next year.

6. What happens if I miss the Annual Enrollment Period?

If you miss AEP, your options to change coverage are limited until the next AEP in 2025. However, certain life events (such as moving out of your plan’s service area, qualifying for Medicaid, or entering a nursing home) may qualify you for a Special Enrollment Period (SEP), which allows you to make changes outside of AEP.

Additionally, there is a Medicare Advantage Open Enrollment Period from January 1 to March 31 each year. During this period, you can switch Medicare Advantage plans or return to Original Medicare if you’re already in a Medicare Advantage plan.

7. How do I know if I need to change my plan?

It’s important to review your current plan’s coverage, costs, and network every year. Some things to consider:

                  •               Did your health needs change in the past year (e.g., new medications or specialist visits)?

                  •               Is your current plan changing its premiums, deductibles, or copayments in 2025?

                  •               Are your preferred doctors and pharmacies still in the plan’s network?

                  •               Do you have a Part D plan that covers all your medications?

By evaluating these factors, you can ensure that your plan still meets your needs.

8. How do I enroll or make changes to my Medicare plan?

You can make changes to your Medicare coverage during AEP in a few ways:

                  •               Online: Use the Medicare Plan Finder tool on Medicare.gov to compare plans and enroll online.

                  •               By phone: Call 1-800-MEDICARE (1-800-633-4227) 24/7.

                  •               Through your plan provider: If you’re staying with your current plan, you can call them directly for assistance.

                  •               Through an insurance agent or broker: Independent agents can help you compare plans and understand your options.

9. What’s the difference between Original Medicare and Medicare Advantage?

                  •               Original Medicare: This includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). You can see any doctor who accepts Medicare, but you may need to purchase a separate Part D plan for prescription drugs and Medigap coverage for additional costs.

                  •               Medicare Advantage (Part C): This is an all-in-one alternative to Original Medicare offered by private insurers. These plans often include Part D coverage, and some offer additional benefits like vision, hearing, and dental care. However, they may have more restricted networks and require referrals for specialists.

10. What should I consider when selecting a new plan?

When comparing Medicare plans, think about:

                  •               Costs: What are the premiums, deductibles, and copayments?

                  •               Coverage: Does the plan cover your medications, preferred doctors, and other healthcare services?

                  •               Convenience: Are the plan’s pharmacy and provider networks accessible to you?

                  •               Benefits: Does the plan offer additional perks like dental, vision, hearing, or wellness programs?

Final Thoughts

Navigating Medicare’s Annual Enrollment Period doesn’t have to be overwhelming. By understanding your options and being proactive, you can make informed decisions that best suit your healthcare needs for 2025. Review your current plan, compare alternatives, and reach out for help if you need it. A little preparation can go a long way in ensuring you have the coverage that’s right for you.

If you have more questions or need further assistance, visit Medicare.gov or speak with a licensed Medicare representative.

 Primetime Health Plan can be contacted at 330-363-7407 or 800-577-5084

Do you have more questions about Medicare or the Annual Enrollment Period? Drop them in the comments below, and we’ll be happy to answer!

Thanks for listening today! We’d like to remind our listeners, if you suspect you have a medical issue, please contact your healthcare provider. Thanks to our sponsor Aultman Health System. As always, we thank our listeners for joining us on Health Matters with the Medicine Center Pharmacy. Have a healthy week and we’ll see you again next Friday right here on News Talk 1480 WHBC.

If you are 65 years old or older, you have been receiving lots of calls, letters, and emails regarding the Medicare Open Enrollment period from October 15 through December 7. What you may not know is that nationally, roughly 70% of Medicare patients do not review their plan during the open enrollment period. That can be scary and leave opportunities to discover unwelcome or unwanted changes in coverage when they visit a doctor, pharmacy, or other provider in the new plan year.

Another fun fact is that Medicare Advantage Plans have become the way that most Medicare Patients receive their Medicare benefits. Around 50% of Medicare beneficiaries chose to enroll in a Medicare Advantage Plan. Advantage Plans became popular because most offer benefits that are not covered by traditional Medicare.

This morning we are fortunate to talk with Trisha Witts from our local five-star advantage plan, PrimeTime Health Plan. PrimeTime is locally owned and when you call, you will be talking to a neighbor or friend to help you understand your Medicare benefits and options.

In this program you can get answers to the following questions about Medicare Open enrollment:

1. What is the Medicare Annual Election Period?

2. What happens if I miss the Annual Election Period?

3. Why is it important to review my plan options?

4. What is the difference between a Medicare Advantage Plan and a Medicare Supplement?

5. If I am on an Advantage plan and go on vacation, am I covered?

6. What is the difference between Medicare Part D and a Medicare Advantage Plan?

7. What is the donut hole and can I avoid it?

8. How can I sign up for Primetime Health Plan? Phone 330-363-7407 or 800-577-5804

Listen to the episode on Apple Podcasts, Spotify, Castro, Stitcher, Amazon Music, or on your favorite podcast platform.

Thanks for listening today! We’d like to remind our listeners, if you suspect you have a medical issue, please contact your healthcare provider. Thanks to our sponsor Aultman Helath Systems. As always, we thank our listeners for joining us on Health Matters with the Medicine Center Pharmacy. Have a healthy week and we’ll see you again next Friday right here on News Talk 1480 WHBC.

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss Medicare Open Enrollment Period with Mike Novelli, Vice President of Aultcare and Denise Fogle, PrimeTime Sales Representative with PrimeTime Health Plan.

It is the annual open enrollment period from October 15 to December 7.  One recent study shows that 9 out of 10 Medicare patients are NOT in the plan best suited for their needs.   It’s not surprising, because, frankly, what could be more confusing than selecting the best Medicare plan for you?  If you find Medicare confusing or are concerned that you aren’t in the best Medicare plan, our show today is dedicated to you.  We want to help you be that 1 in 10 patients who found the best plan to meet their needs.  Please join us today as we learn about Medicare Plans during Open Enrollment.

Some of the topics covered in this program:

1. What is AEP when it comes to Medicare plans?

2. What type of changes do beneficiaries make during AEP?

3. What happens if someone would miss the timeframe to change during AEP?

4. What is the benefit of having an Advantage plan over Original Medicare A & B?

5. What happens if my doctor is not in the network of the Advantage plan?

6. What happens if I’m on an Advantage Plan and go on vacation; am I covered?

7. What if I have to go into the hospital while out of network? Is that covered?

8. Can you explain a formulary and what it means to find your medication on a formulary?

9. The term donut hole relates to Medicare Part D Coverage. Can you explain what the donut hole is and if everyone falls into it?

10. What are some other benefits on PrimeTime Health Plan HMO-POS that you don’t get with original Medicare?

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Thanks for listening today! We’d like to remind our listeners, if you suspect you have a medical issue, please contact your healthcare provider. Thanks to our sponsors Studio Arts & Glass . As always, we thank our listeners for joining us on Health Matters with the Medicine Center Pharmacy. Have a healthy week and we’ll see you again next Friday right here on News Talk 1480 WHBC.