For clients who are retired and who are eligible for Medicare, this governmental program is a key tool to manage and cover their healthcare costs. Once they enroll initially, they still need to stay on top of both what Medicare covers and their own changing healthcare needs.
Each year from Nov. 7 through Dec. 15, there is an open enrollment period when current Medicare users can change their coverage. This generally cannot be done throughout the rest of the year. Retirees and others who are eligible can certainly benefit from their advisers’ help and guidance as they review their coverage against their anticipated needs for 2021. Here are some ways advisers can help clients prepare for the upcoming open enrollment period.
Changes in Medical Needs
A big driver for many people to change their Medicare coverage options are changes in their medical needs. This might be a change in their prescription medications, a change in the doctors or medical professionals they use or a new medical condition for which they require treatment.
Their revised medical needs may not be fully covered under their current plans. For example, a new prescription drug might not be covered under their current Medicare Part D prescription drug plan. Or a new doctor might not be in-network in their Medicare Advantage plan.
Additionally, clients may want coverage for services and procedures not covered under Medicare Parts A and B, known as traditional Medicare. There are numerous examples that could be cited. For example, your clients might be developing hearing problems and would like to find a plan such as a Medicare Advantage plan that offers coverage for these services not covered under traditional Medicare.
Plan Coverage Changes
Their prescription drug plan, their Medicare Advantage plan or a Medicare Supplemental plan might have changed their coverage options. Or perhaps a medical facility such as the hospital your client uses is no longer in-network. Their local pharmacy might now be out-of-network. Or your client’s preferred doctor may no longer be in-network for your client’s plan.
Here are some examples of changes that your client might make in their Medicare coverage based on their medical situation and anticipated needs for the upcoming year.
- Going from original Medicare plus a drug plan to a Medicare Advantage plan that includes prescription drug coverage
- Moving from a Medicare Advantage plan back to original Medicare
- Changing Medicare Advantage plans due to coverage issues and/or perhaps to take advantage of the better features of a new plan
- Changing Part D prescription drug plan providers for coverage or features issues
There are other adjustments in their plans or coverages that clients might make going into the new year based on their circumstances.
Navigating Open Enrollment
Advisers can best serve their clients by being sure Medicare is on the agenda for a client meeting prior to the open enrollment period. Make sure that your clients are aware of this upcoming open enrollment period and help them to establish a process to take stock of their current coverage in light of their needs.
Especially when it comes to prescription drugs, this might mean helping them (or encouraging them) to do a spreadsheet listing all of their medications to help them ensure they are all covered in order to avoid having to pay out-of-pocket for a full year until the open enrollment period the following year.
Compile a list of resources for your clients. These might include various websites or connections to Medicare experts to whom you can make referrals. In the latter case, of course you will want to understand what services these experts provide and whether or not they sell any Medicare policies. Whether they only provide advice or receive commissions is not the issue, but you will want to be sure they do only what’s best for your clients and that any fees or commissions they receive are fair and reasonable.
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Make sure your clients are making good decisions. For example, getting a lower premium on a new Medicare Advantage plan might not be a good deal if the coverage for an extended hospital stay is not fully covered. This dovetails well with the long-term financial planning work you’ve done with them to get them to retirement, and that you will continue to do with them to navigate their way through retirement.
The cost of healthcare in retirement is a major expense for many. Medicare can be a great help in managing these costs, but it is a complex system at best. Your clients need your help to navigate open enrollment each year to be sure they are making the best choices for their situation.