Ep. 298 – 5 Things to Know About Medicare Advantage Open Enrollment Period for Retirement

CLICK HERE TO SUBSCRIBE

In this Episode of the Secure Your Retirement Podcast, Radon and Murs discuss the complexities of the Medicare Advantage Open Enrollment Period with Shawn Southard, the Medicare aficionado at Peace of Mind Wealth Management. If you’ve ever felt overwhelmed by the intricacies of Medicare Advantage plans, prescription drug coverage, or Medigap policies, this episode is a must-listen. Shawn breaks down the options available, clarifies the rules for switching plans, and highlights key considerations for ensuring your Medicare coverage fits your unique needs.

Listen in to learn about the differences between Medicare Advantage and original Medicare, how to navigate maximum out-of-pocket costs, and what to look for when considering switching plans. Whether you’re planning retirement, retiring comfortably, or just looking to secure your retirement, understanding your Medicare options is crucial for avoiding costly mistakes.

In this episode, find out:

·      The key differences between Medicare Advantage plans and original Medicare.

·      How Medicare Advantage Open Enrollment works and what changes you can make.

·      The importance of evaluating Medicare Advantage networks and prescription drug coverage.

·      Potential pitfalls when switching to original Medicare and Medigap policies.

·      How maximum out-of-pocket costs and co-insurance impact your financial planning.

Tweetable Quotes:

·      “Understanding your Medicare Advantage plan can mean the difference between peace of mind and unexpected financial stress.” – Radon Stancil

·      “Your healthcare coverage should work for you, not against you. Take the time to explore your options.” – Murs Tariq

Resources:

If you are in or nearing retirement and you want to gain clarity on what questions you should be asking, learn what the biggest retirement myths are, and identify what you can do to achieve peace of mind for your retirement, get started today by requesting our complimentary video course, Four Steps to Secure Your Retirement!

To access the course, simply visit POMWealth.net/podcast.

Here’s the full transcript:

Radon Stancil: Medicare Advantage Open Enrollment: What Do You Need to Know?
In this episode, we’re going to cover five things you need to know about open enrollment for Medicare Advantage. We hope you’ve been enjoying all the episodes from Secure Your Retirement. If you’d like to keep learning and receiving these episodes, hit the subscribe button and the bell so you receive alerts when they come out. We’ve helped thousands of listeners get on the path to securing their retirement. Now it’s your turn. Let’s dive in.

Radon Stancil: Welcome to Secure Your Retirement Podcast. Today we’re talking about Medicare, and we have our Medicare guru, specialist, Shawn Southard, who heads up that for us in our office here at Peace of Mind Wealth Management. So, Shawn, thank you for coming on to the show today.
Yes, thanks for having me.

Radon Stancil: So the reason why I asked Shawn to come on today and talk to us is there are different times of the year that you can do certain things within Medicare, and one of those times is just starting right now. We just lived through what’s called an open enrollment. And now we’ve got this other open enrollment. So we thought, hey, so that we can understand all this and make sure that we understand how it works, we’d have Shawn come on and kind of talk to us a little bit about that. So I’m going to let you kick this off, Murs, and kind of help us get this understanding.
Yeah. So there’s, like you said earlier, or I guess in 2024, end of 2024, we had open enrollment. Now we’re walking into another one. So, Shawn, what is it? What’s Medicare Advantage in general on a high level? And how long does this period last?
Sure.

Shawn Southard: So, there are really three open enrollments in Medicare. One was the one we all know very well, which happens in the fall—October 15th to December 7th—that’s called Medicare Annual Enrollment, where all Medicare beneficiaries can make changes. And then there’s a Medigap Open Enrollment, which is specific to that product. The first six months after someone is new to their Medicare coverage, they can get into Medigap plans with no medical underwriting. And then there’s this third one, which starts on January 1st. So, we’re already in it; it goes to March 31st, the first quarter of every year. It’s called Medicare Advantage Open Enrollment (OEP).

Basically, Medicare Advantage plans are an alternative way for people in Medicare to get their health insurance coverage. They are sponsored by private insurance companies and are an alternative to Original Medicare. During this time period, if you are enrolled in a Medicare Advantage plan at the start of the year—say, you’re in it in 2024, rolling into 2025—and you did not make a change during the fall Annual Enrollment Period, and you want to make a change now, you can do it. Or, if you did make a change during the fall and you don’t like what you did, or the plan isn’t what you thought it was going to be, you can also make a change during this time period. Medicare allows you to make one change, and it will be effective the first of the following month during this time period.

Radon Stancil: Excellent, well, thank you for giving us that background. So, basically, open enrollment means that I don’t have to go through underwriting, I can make changes freely, and I’m open to do it. What kind of changes can be made during this period of time?
The main changes that happen during this time period are either people are changing from one Medicare Advantage plan to another, or they are disenrolling from Medicare Advantage altogether. Medicare allows you to disenroll from your Medicare Advantage plan during this time period, and go back to what’s called Original Medicare—Parts A and B. The strategy there is that the person disenrolling from Medicare Advantage wants to get into a Medigap, or what’s known as a Medicare Supplement Plan.

Shawn Southard:The reason why they have to disenroll is that Medicare does not allow an individual to be simultaneously enrolled in a Medicare Advantage plan and a Medicare Supplement or Medigap Plan.

Radon Stancil: Hey, real quick on that one, Shawn. If you disenroll from Medicare Advantage and go back to Original Medicare—A and B—and do that supplement the way you’re saying it, is there any kind of underwriting I have to go through on that side? Or can I just move over to the A and B side of Medicare and into a Medigap policy?
Shawn Southard:: That’s a great question, Rayden. If you do disenroll from a Medicare Advantage plan and you want to go back to Original Medicare with a Medigap, if you’re outside of your six months being new to Part B of Original Medicare, then most carriers will require medical underwriting for that policy.

Radon Stancil: Now, there is something—this could be another podcast topic—but there is something called a “trial right.” If you’re new to Medicare and started with Advantage first, and as long as you make that change within the first 12 months, you can switch to a Medigap without medical underwriting. But otherwise, people are generally required to be medically underwritten for those Medigap policies.

Murs Tariq: Gotcha. Okay. So that leads me to my next question—why would someone make a change? I’ve got a handful of ideas, but do you find that, often in your conversations, people just didn’t know what they were signing up for? Or maybe they were confused about the process?
Absolutely. Medicare is very confusing to navigate, and many people don’t fully understand what they’re signing up for. One of the biggest reasons people make a change during this time is prescription drugs. The prescription drug component is a big part of many people’s healthcare plans. Often, when the new year starts, people realize that the formulary—the drug menu, essentially—doesn’t work well with their specific drug regimen, which creates pain points. That drives a lot of people to make changes.

Shawn Southard:Another reason is network restrictions. Remember, Medicare Advantage plans are HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations), which means they involve specific networks of doctors and hospitals. A lot of times, people switch from an HMO to a PPO because they want a wider network or some out-of-network benefits.

Additionally, there are ancillary benefits that vary among plans, like vision coverage, dental coverage, hearing exams, and fitness programs. Those extras can also drive people to switch plans.

Radon Stancil: Excellent. So I guess moving on to point number four, are there any pitfalls people need to watch out for when making these decisions?
Yes, absolutely. One major pitfall is that when people switch back to Original Medicare from a Medicare Advantage plan, they may end up on Original Medicare only—without a Medigap plan. This is a financial risk because Original Medicare has significant gaps in coverage, including copays and coinsurances, which can add up quickly, especially if someone becomes seriously ill.

Shawn Southard:Before disenrolling from Medicare Advantage and switching back to Original Medicare, you need to ensure that you can afford the Medigap premiums and that you qualify medically for the plan. Being on Original Medicare without a Medigap plan can leave you financially vulnerable.

Murs Tariq:Got it. So, if someone listens to this episode and it’s the first time they’re hearing about open enrollment for Medicare Advantage, what tips would you give them as they start thinking about whether or not they should make a switch?
Great question. First, remember that Medicare Advantage plans are offered by private insurance carriers. These plans are regulated but have their own specific rules and benefits. It’s essential to really understand how your current plan works or any plan you’re considering for the future.

Radon Stancil: Second, you need to be aware of the Maximum Out-of-Pocket (MOOP) limit for your plan. Some plans have high MOOP amounts—$8,500 or $9,200, for example—which means that’s the maximum you’d have to pay out of pocket during the year before the plan covers 100% of your expenses.

Shawn Southard:Lastly, consider coverage for major medical issues like cancer. Medicare Advantage plans often have a 20% coinsurance clause for treatments like chemotherapy, which can quickly add up against the MOOP. Understanding these details can help you avoid surprises later on.

Radon Stancil: Excellent. So, wrapping this up, Shawn, how can people navigate this process and keep it simple?
They can contact me. I’ve been working in healthcare, health insurance, and Medicare for over 23 years. I offer personalized services to help people navigate these confusing decisions, and there’s no cost to work with me.

Excellent. Well, Shawn, we appreciate you coming on. For anyone listening, if you want to talk to Shawn, you can call our office at 919-787-8866. Shawn also hosts a Medicare Lunch and Learn on the first Monday of every month here in our office, which is a great opportunity to ask questions in a small group setting. Space is limited, so be sure to call and reserve your spot.

Thanks again, Shawn.

Shawn Southard:Thank you.

Radon Stancil: We hope you’ve enjoyed this episode of Secure Your Retirement. If you’d like to learn more, check out our online course, Three Keys to Secure Your Retirement, available on our website, pomwealth.net. Don’t forget to subscribe to the Secure Your Retirement podcast!