There’s 3 big mistakes to avoid with Medicare open enrollment

Even if your Advantage plan or drug coverage served you well this year, there’s no guarantee that you’ll feel the same way in 2021

While insurers are federally regulated, the specifics of their options can vary greatly from plan to plan, county to county and year to year. Changes can affect your premiums, deductibles, co-pays and covered services, along with participating doctors, hospitals, pharmacies and other providers.

The average monthly premium among Advantage Plans change year after year. Regardless of what that payment would be, keep in mind that it’s in addition to your Part B premium for most people. The official word on the 2021 for Medicare Part B premium is $148.50 rising from $144.60 in 2020 (Higher-income beneficiaries pay more.)

Of course, premiums are are not the only factor you should consider.

“The lower premiums have higher deductibles and copays, and the higher premiums tend to have lower amounts for those,” said Danielle Roberts, co-founder of insurance firm Boomer Benefits in Fort Worth, Texas. “Look at what it will cost you overall.”

The average out-of-pocket limit for in-network services among Advantage plan enrollees in either HMOs or PPOs this year is at max $7,750, according to the Kaiser Family Foundation.

You should know your worst-case scenario and be prepared to afford the maximum out-of-pocket for the plan you choose.

However, as with Advantage Plans, a lower premium doesn’t necessarily mean your total out-of-pocket cost would be less.

Depending on the plan’s formulary — how it prices the drugs it covers — and the coverage restrictions in place, the amount you pay for certain drugs could be lower or higher in 2021.

You can compare coverage through the Medicare.gov tool, although be aware that some of the information you’re given may be incomplete.

You might have to look at the plan’s formulary to get details on things like whether you’d have to try out cheaper alternatives first (so-called step therapy) or if there are quantity limits on the medicine you take.

To make sure your doctor, pharmacy or other provider is still in network, you also have to check with the insurance company that offers the plan. You can either visit the provider’s website or call.

≤ The number of Advantage plans you can pick from largely depends on where you live. The more rural the area, the fewer the options you’re likely to have. However, in Chautauqua County, new plans have become available, as insurance carriers expand their options and coverage areas and new players enter the market. This makes it important to make sure there isn’t a more cost-effective option for you.

New stand-alone prescription drug plans also could be available in Chautauqua County which makes it worthwhile to comparison-shop.

Your plan might be great, but if one similarly priced saves you $500 next year, you’d probably want to know about that if you don’t do the analysis, you might miss out on that savings.

≤ If your health is good, that’s great. If you assume it will never go downhill, that might not be so wise.

Remember, original does NOT cover everything. While everyone’s situation is different, it’s important to at least consider the unknown.

For example, while you might take no medicine now, there’s a good chance that will change, whether due to aging, an accident or an unanticipated medical event.

More than 80% of people age 65 and older take at least two prescription drugs and more than 50% take four or more, according to an AARP survey in 2016. In other words, it can be worthwhile making sure your coverage accounts for the unexpected.


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