Latest / USA House Partners Podcast / Medicare Open Enrollment Preview — Read Your Letter Before October 15
Transcript
- Greg Raymer: See this envelope? There's a good chance one just like it is sitting on your kitchen counter right now. It came from your Medicare plan. It's thick, it's boring, and most of us toss it in the door and forget about it. This year that could be an expensive habit. Stick with me for the next few minutes and I'll show you exactly what you look for in that letter. Before Medicare Open Enrollment opens on october fifteenth. Hey everybody and welcome to a Senior Moment Podcast. I'm broker Greg. Every Thursday we take one topic that matters to seniors and caregivers. Talk about it in plain English with no jargon, no sales pitch. One quick note up front. I'm a real estate broker, not an insurance agent. I don't sell Medicare plans and I'm not going to tell you which one to pick. My job today is just help you ask the right questions and then point you to free, unbiased help right here in South Central Kentucky. Here's the plan. First, the calendar and that letter in your mailbox. Second, prescription drug coverage. What's changing for twenty twenty seven? Third, Medicare Advantage Networks because this is a year when a lot of plans are changing. And then a simple checklist you can do this week. Let's start with the dates because they matter. Medicare Open Enrollment runs from October 15th through December 7th. Whatever you choose during that window takes effect January 1st. So today you've got about a two-week head start. Use it. Now that envelope, it's called the annual notice of change. You'll sometimes hear it called the ANOC. If you're in a Medicare Advantage plan or a Part D drug plan, your plan had to mail it to you by the end of September. It comes from your plan, not from Medicare and not from Social Security. And here's why it matters. That letter has to spell out every change your plan's making for the next year. Your premium, deductible, your co-pays, what drugs are covered. Which doctors and hospitals are in the network, it's all in there. And here's the trap. If you do nothing, most plans simply renew. And a lot of th folks think, well good, nothing changes. But renewing is not the same as staying the same. You can have the exact same plan next year and a very different plan. If your plan's leaving Medicare entirely or pulling out of your county, you'll get a separate letter called a non-renewal notice. That one's a big deal, and we'll talk about it in a few minutes. And if you didn't get your letter, call the member services number on the back of your insurance card and ask for it. Caregivers, this is a great week to check mom or dad's mail pile. Let's talk prescriptions. This is the part that surprises people the most. I'm gonna go slow. First, there's some good news that's sticking around. Since last year, Medicare has had a yearly cap on what you pay out of your pocket for covered drugs. Once you hit it, Your cover prescriptions cost you nothing for the rest of the year. For 2027, that cap is $2,400. That's up from $2,100 this year. So it's a higher ceiling, but it's still a ceiling. Before 2025, there wasn't one at all. Second, the deductible. What you pay before your plan starts sharing costs can be as high as $700 next year, up from six hundred and fifteen now. And one important detail: that $2,400 cap covers your co-pays, co-insurance, and deductible. It does not include your monthly premium. You keep paying that premium all year no matter what. Third, and this is the one to watch if you have original Medicare with a separate drug plan. A temporary federal program that's been helping hold down premiums on those standalone drug plans ends after this year. What that means for your plan, nobody can say in general. Some premiums may go up, some may not. Your letter will tell you. If you get extra help, With your drug costs, you're largely protected from this. A few things that are staying the same. Covered insulin is still capped at $35 a month, and recommended adult vaccines are still no cost under Part D. And if you've got one expensive drug early in the year, every Part D plan has to let you spread those costs out in monthly payments instead of paying a big chunk in January. Ask your plan about the Medicare prescription payment plan. Now The most important word in this whole episode, formulary. That's just a fancy word for your plan's list of covered drugs. Every plan has its own and it can change every year. So when you open that letter, look up every single medication you take and ask four questions. One, is it still covered? Two, did it move to a different tier? A drug moving up to a tier can mean a noticeably bigger copay. Same drug, but Same plan, more money. Three, are there new rules like needing approval first from the plan or trying a cheaper drug first? And four, is your pharmacy still a preferred pharmacy? Here's the honest truth. No one, not me, not an agent, not the TV ads, can tell you your exact twenty twenty seven cost until your actual drugs are plugged into an actual plan. That's the only number that counts. If you have a Medicare Advantage plan, that's the all in one kind. Usually with a card from a private company, this is your segment. Big picture. This is a year when a lot of insurers are trimming. Humana has said its planned exits will affect roughly six hundred thousand members nationwide, and United Healthcare has signaled cutbacks too. Rural counties tend to feel it the most because there are fewer plans to begin with. Now, that does not mean your plan is changing. Medicare Advantage is sold county by county. The headlines can't tell you what's happening to you, only your letter can. So here's what to check. Call your doctor's offices, your primary care doctor, and every specialist and ask one simple question. Will you be in network with my plan in 2027? Ask the same about the hospital you want to go to. Check your pharmacy, look at your maximum out of pocket for the year, and look at the extras, dental, vision, hearing, over-the-counter allowances, gym memberships. Those are often the first things trimmed. Now Two very different situations. If you get that non renewal notice, meaning your plan's going away, you get a special enrollment period that runs past december seventh and you get a guaranteed right to buy certain Medigap supplement policies without being turned down for your health. Don't wait until the last minute, but know you have options. But if your plan is just getting worse, like higher copay, smaller network, you don't get any special window. October fifteenth to december seventh is your chance. Don't renew on autopilot. One word of caution if you're thinking about leaving Medicare Advantage and going back to original Medicare with a supplement. Outside of those guaranteed situations, in most states the supplement companies can ask health questions, and they can charge you more or say no. So get answers before you switch, not after. And one small safety net. If you're in Medicare Advantage on January 1st and realize you made a mistake, there's another window from January 1st through March 31st where you can make one change. But plan on getting it right now. Alright, here's your to-do list for this week. One, find that letter. Two, make a list, every medication with the dose, every doctor and your pharmacy, caregivers, do this for your parents. It turns a two hour phone call into a twenty minute one. Three, compare. You can do it yourself on the Medicare Plan Finder at Medicare dot gov. The twenty twenty seven plans show up there in early October. Or you can get free help, which I'll give you in second. Four, put October fifteenth and december seventh on your calendar. And five, watch out for the scams. This is prime season. Medicare will not call you out of the blue and ask you your Medicare number. Nobody can lock in a special rate over the phone. And those TV commercials that say call now. Those are marketers, not Medicare. If someone calls you, hang up and call the number on your own card. Now, the free help. Kentucky has a program called SHIP. That's SHIP, the State Health Insurance Assistance Program. They're trained counselors. They don't sell anything and it costs you nothing. They'll sit down with your list and compare plans using your actual drugs and your actual doctors. Here in our area, it's run through Kentucky Legal Aid and Bowling Green. That number is 270-782-5740 or toll-free 1-866-452-9243 Monday through Thursday. Anywhere in Kentucky, you can call the statewide ship line at 1877-293-7447. And of course, there's always 1-800 Medicare. My advice, call this week. Once October fifteenth hits, those appointment calendars fill up fast. Before I let you go, here's something most people never think about. Your Medicare plan, especially Medicare Advantage and Part D, doesn't follow you, it lives at your zip code. So if you're thinking about downsizing, moving closer to the kids, or moving into assisted living in the next year or so, your plan choices may change with the address. Usually a move opens up a special window to change plans, but the plans available at the new place and whether your doctors are in them can be very different. That's why I tell families, think about the house and the health plan together. Timing matters on both. If a move's on your horizon, I'm glad to talk it through, whether that's a straightforward sale, quick cash offer through our investor network, or zero commission home selling system. No pressure, no obligations. Just send me a message right here on Facebook. That's it for this week. Find the letter, make your list, and call ship. And do me a favor, share this episode with somebody who's got one of those envelopes setting on their counter. Next Thursday, we'll talk fall vaccines, flu, COVID, RSV, shingles, and pneumonia. Who needs what and what Medicare covers. I'm broker Greg. This has been a Senior Moment Podcast. I want to thank you for joining me on our search for good-to-know senior facts and the truth. With that said, I'd like us to remember the words of the Gospel of John, chapter eight, verse thirty two, and you shall know the truth, and the truth shall make you free. Take care of yourselves, and I'll see you next Thursday.