Roger Maris, who broke Babe Ruth’s record of single season homeruns, once stated that, “You hit homeruns, not by chance but by preparation.” It’s an adage we live by at Healthassist, especially as annual Open Enrollment season approaches.

How We Are Preparing

We are very excited about the next component of the Inflation Reduction Act of 2022 being implemented in 2025 and are closely monitoring how this will occur administratively. This component included a redesign of the Part D prescription drug program and is taking place incrementally, with new cost saving initiatives introduced each year. 

Some highlights:

• In 2023 and 2024, when the monthly cost of insulin capped at $35, many Medicare recipients with fixed, limited incomes saw a dramatic decrease in their prescription drug bills. Also, recommended vaccines became available to Medicare recipients with no cost sharing.
• In 2025, Medicare will limit out-of-pocket costs for Part D prescriptions to $2000 per calendar year. Further, to avoid potentially paying $2000 the first month on the plan, the IRA includes a Part D “prescription payment plan,” allowing Medicare beneficiaries to break down their prescription drug costs into equal monthly payments. 

We will reach out with 2025 plan options to those Medicare clients who might benefit from a comparative analysis of their current Part D prescription drug plan.

Other ways we are preparing…

• Our team will attend The Centers for Medicare & Medicaid Services (CMS) trainings, to ensure our clients benefit fully from these programs.
• We will watch closely as Medicare begins negotiations (for the very first time) with drug manufacturers to comply with the Inflation Reduction Act directive to reduce certain prescription drug costs beginning in 2026.
• We are tracking regulatory changes and insurance industry adaptations that will impact the cost, coverage, and delivery of healthcare services in 2025. Examples of Medicare-related changes include adjustments to Medicare Part B monthly premiums; changes to Income Related Monthly Adjustment Amounts (IRMAA); changes by insurance providers to premiums, deductible, and out of pocket amounts; and more.
• We have added Linda Braun as a new member of our team of Insurance Advisors. Linda comes to us with more than 25 years of healthcare industry experience, and we are fortunate she joined us well in advance of Open Enrollment season.
• We will be conducting our complimentary Open Enrollment webinar: From Deductibles to Donut Holes, How to Decipher Your Medicare Choices, on October 30th at 1:00 PM ET. We will be releasing more information about this webinar in the coming days. To register early for the event, please click here. 

We Can’t Do It Without YOU

We are eager to guide you through Open Enrollment. But hitting a homerun is a team effort and requires some work on your part. Here are some things you can do to prepare…

Read your mail.

By September 30th, Health plans are required to mail an Annual Notice of Change (ANOC). This is not junk mail! It may include things such as premium and deductible increases or changes to the formulary (list of covered drugs) and requirements to obtain these drugs (prior authorization, quantity limits, etc.).

For example, we had a client who failed to note the elimination of one of her prescription drugs from one year to the next. When she went to fill her prescription, she learned it was no longer covered — at that point, it was too late to change plans. (While there is a process for requesting a “formulary exception,” it is administratively burdensome on both the prescribing physician and the patient.)

Make note of any prescription drug changes.

• Have any drugs been eliminated or added to your list?
• Has dosage or frequency of use changed?
• Do you anticipate any prescription drug changes in the year to come?
• Have you decided to use a different pharmacy? 

Although such changes may seem minor, they can have a major impact on the cost of your drugs.

Pay close attention to Medicare Advantage plan changes.

These can be significant. Recently, Newsweek reported that 40,000 Medicare Advantage members will be forced to make plan changes, as a significant number of insurers are exiting the market entirely (see link to article below). Even if your insurer remains, make sure to do the following:

• Check the network participation of your doctors and preferred hospitals.
• Note the differences between HMO and PPO plans.
• Review your copays, deductibles, and out-of-pocket maximums to ensure there are no significant changes.

If the plan changes are not acceptable to you, you may choose a new plan during Open Enrollment. If you fail to enroll in a new plan, you will be automatically reenrolled in the same plan for the following year, something that may not meet your needs or cost significantly more.

Beware of aggressive marketing tactics.

Open enrollment invites aggressive marketers employing unscrupulous tactics to entice you into choosing their plan. You may receive phone calls, mailings, and emails from sources impersonating government officials and insurance companies. Do not provide any personal information and do not enroll in something without careful analysis. 

However, when you are conducting new enrollments into Medicare Part A and/or B during your Initial Enrollment Period (IEP), a Special Enrollment Period (SEP), or the General Enrollment Period, Social Security and CMS may get in touch. Click here for guidance on what types of legitimate communication to expect and how to verify the source. 

Summary

It can be tempting to stay with “the devil you know,” thereby forgoing the opportunity and effort of making insurance changes. This can be especially inviting in a presidential election year when there is already so much noise and chatter to sift through. 

But please remember we enjoy the right and privilege to choose the type(s) of coverage that will provide access to the healthcare we need and want. The choice is yours to make.