COLUMN: How to shop for Medicare coverage during open enrollment

You’ve heard people say it, and you’ve undoubtedly said it yourself. Given a lot of choices, we might say, “iIt’s almost like Christmas!”

Medicare open enrollment might be a bit like that, with dozens of options for how Medicare beneficiaries may insure themselves for medical and prescription drug costs.

You could accuse this column of “getting into the weeds,” so let’s break it down into bite-sized pieces from which you may pick and choose.

Open enrollment’s what and when: Known officially as the annual election period, this is the time that a Medicare beneficiary may review Medicare Advantage and prescription drug insurance plans against what they already have. Open enrollment runs each year from Oct. 15 through Dec. 7. If one enrolls in new insurance during that time, the new coverage will begin Jan. 1 (and the prior insurance is automatically canceled at midnight on Dec. 31).

2025 insurance plans may be posted on the Medicare.gov website as early as Oct. 1. A prompt on the webpage will tell you whether you are reviewing plans for 2025 or 2026. (The open-enrollment dates also apply to those with income-related Medicare benefits such as the Medicare Savings Plan; until this year, these beneficiaries were able to change insurance plans outside of open enrollment.)

Open enrollment doesn’t apply to everyone: If you have Medicare supplement (Medigap) insurance, these open-enrollment dates don’t apply to you. Theoretically, you could change Medigap policies at any time. However, to do so without risk of incurring a higher premium because of a pre-existing health condition, beneficiaries are advised to use Oregon’s Medigap birthday rule.

How to review insurance plans: 2025 Medicare Advantage and prescription drug insurance plans may be reviewed on the Medicare.gov website, perhaps as early as Oct. 1. Be sure you’re on the official Medicare.gov site and not on one trying to mimic the federal site.

To get started, where you see Health & Drug Plans at the top of the Medicare.gov homepage, click on the drop-down menu and select Find health & drug plans. It’s reasonably intuitive from there.

Finding help reviewing Medicare insurance options: Although you can very likely do this yourself, beneficiaries will find several options for assistance. 

• Volunteer SHIBA counselors: These are Medicare-trained volunteers in the federal-state Senior Health Insurance Benefits Assistance program. They provide free counseling – in the office or by phone or Zoom – about Medicare insurance and other Medicare topics. If you are a Marion County resident, you can make an appointment with the Salem office by calling 503-304-3479; if you live in Polk County, call the Dallas office at 503-831-0581.
• Insurance brokers who handle Medicare insurance: These are knowledgeable agents who can assist with the plans that they represent. Some are state-certified insurance brokers, who have passed a test of their Medicare knowledge and who have no substantiated complaints against them.
• Medicare offers a 24/7 phone helpline to assist beneficiaries: 800-MEDICARE (800-633-4227). 
• The Oregon Department of Human Services staffs a SHIBA helpline at 800-722-4134; don’t enter your ZIP code, just stay on the line. Calls are answered during normal weekday business hours. If calls are backed up, your call may be routed to the national Medicare line (see above) with its “Welcome to Medicare” greeting. 

How many insurance plans? More than 25 Medicare Advantage plans that cover both medical and drugs are available to Marion and Polk county residents. In reviewing plans, be sure the one you select offers both medical and drug coverage (unless you have VA drug coverage, in which case separate drug insurance coverage is nevertheless advised).

Prescription drug plans, meanwhile, are statewide insurance plans usually purchased by Medicare beneficiaries who have Medigap policies or who have Original Medicare (that is, Medicare Part A and Part B only). In 2024, Medicare beneficiaries could choose from among 12 drug plans.

What do they cost? Monthly premiums for Medicare Advantage plans that cover both medical and drug costs this year range from zero (no premium) to $192. 

Monthly premiums this year for prescription drug plans, meanwhile, range from zero (no premium) to $110.10. You will see that many plans have annual drug deductibles ($590, say), although that is factored into your full-year drug price that you will see on the website.

When can we see 2025 insurance plans? Plans are often posted on the Medicare.gov website by Oct. 1, although one may enroll no earlier than Oct. 15. 

How best to compare plans? Factors to review differ by the type of plan you’re considering.

• Medicare Advantage plans: Major factors to consider are whether your doctors are “in network” with the insurance (that is, they can bill the insurance); whether the plan covers your prescription drugs; the monthly premium and your drug costs; the maximum that you could have to pay for medical care during the year; and co-pays for various medical services, especially those you believe you’re most likely to use.
• Prescription drug plans: Here, you’ll review whether the plan covers your prescription drugs, the price of those drugs at the pharmacy (or by mail order), and the plan’s monthly premium. Be certain, too, that your pharmacy is in network with the insurance (that would be either a Standard or Preferred pharmacy).

For both types of insurance, it’s also worth noting the star rating whose components include customer satisfaction. 

Other good-to-know items: During September, Medicare Advantage insurance companies are required by law to send their insureds an annual notice of change (ANOC) document outlining next year’s change in monthly premium and benefits; changes in prescription drugs they cover; and any changes in doctor or pharmacy networks.

To avoid surprises, it’s worth carefully reviewing the ANOC document to see if any changes would affect you adversely. For example, it would be highly inconvenient going into the new year to learn your doctors were no longer in network with the insurance you have.

During annual open enrollment, some beneficiaries report receiving insurance sales calls. It is legal for a company to phone you or knock on your door only if the company has had a prior relationship with you.

Granted, saying that open enrollment might be a little like Christmas could be a stretch. But the insurance choices are indeed plentiful, and finding the one that’s the best for you can be a gift.

Jim Sellers of Salem is a certified Medicare counselor with the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, e-mail [email protected]. To schedule a free SHIBA phone, Zoom or in-person appointment with a volunteer Medicare counselor, please call 800-722-4134.

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