Alignment Healthcare

With Medicare’s enrollment period deadline of Dec. 7 coming up, be sure to evaluate your Medicare health and drug coverage before time runs out. A little-known secret is that Medicare members who are currently enrolled with a Medicare Advantage plan are automatically disenrolled when they enroll in another plan, so it’s wise to check your enrollment status whenever making any changes. All plan updates take effect Jan. 1, 2023.

Here are seven tips to help you make the right choice:

1. Evaluate your current plan.

Fully evaluate and understand what’s included in your current one before making any changes. Consider the benefits you’ve been using, what services are lacking, and how much you’ve been paying. Ask yourself important questions like: Do I have a high monthly premium? Have I been paying out-of-pocket for necessary services that are not included in my plan? Am I happy with my plan’s current providers? Understanding how you’ve been using your current plan in the past year is a good first step.

2. Understand all of your options.

Once you’ve evaluated your current plan, it’s important to know the changes you can make during open enrollment.

• Switch from Original Medicare to a Medicare Advantage plan

• Change from one Medicare Advantage plan to another

• Switch from Medicare Advantage to Original Medicare

• Sign up for a Part D prescription drug plan

• Change from one Part D prescription plan to another

• Cancel your prescription drug coverage

3. Consider the differences between Medicare Advantage and Original Medicare.

Now that you know your options, it’s good to familiarize yourself with the differences between Medicare Advantage and Original Medicare.

Original Medicare (also known as Part A and Part B) only offers hospital insurance and medical insurance, requiring you to purchase a separate Medicare Part D plan for prescription drug coverage, and Medigap for supplemental coverage to pay for expenses not covered by Medicare. 

Medicare Advantage (also known as Medicare Part C) is an alternative to Original Medicare, offering everything that Original Medicare offers plus more, all in one plan. For example, Alignment Health Plan will offer a range of different Medicare Advantage plan options for 2023 in Arizona, California, Nevada, Florida, Texas, and North Carolina so that you can find the right one to suit your specific needs.

Many Medicare Advantage plans like Alignment Health Plan, include supplemental benefits, such as hearing, dental, and vision care, gym or fitness programs. Most Medicare Advantage plans also include Medicare prescription drug coverage (Part D), have low or no premiums, and lower deductibles.

4. Check out the providers associated with plans.

Review the provider networks that are a part of the plans you are considering. Since it’s possible that doctors, clinics and hospitals you have used for years do not accept certain plans, the plan you choose may not cover out-of-network providers or may charge a higher deductible and copayment for using them. Also consider plans that offer you flexibility in how they offer care. For example, Alignment’s popular and highly rated Care Anywhere program delivers personalized, timely and coordinated care wherever members need it -- – at the senior’s home, in a healthcare facility or through a virtual channel.

5. Look for plans that include virtual care.

Telehealth will increasingly become a standardized part of care, as providers look to closely monitor chronic diseases to improve patient care and outcomes. Medicare Advantage plans can include additional benefits such as in-home health visits. To offer seniors with flexibility and convenience in accessing care, Alignment Health Plan offers a range of virtual-first plans.

6. Check out resources and consult with experts.

Still overwhelmed? You’re not alone. To find out more about Medicare annual enrollment and which plans are available to you by zip code, go to Medicare Plan Finder at Medicare.gov or onto the plan’s website.

If you need an expert’s opinion to help you make your decision, you can consult with a licensed health care broker – an insurance agent who can help you compare plans, benefits, and out-of-pocket expenses, and make sure you have the right coverage for your health needs. Insurance brokers represent a range of Part C, standalone Part D plans and Medicare supplement plans and can help you make your choices.

You can also look for recognitions awarded to plans by reputable organizations. For example, Alignment Health Plan has earned the 2022 Senior Choice Gold Award in San Francisco, San Joaquin, Santa Clara and Stanislaus counties in California.

7. Remember the next health plan change deadline.

Although the annual Medicare enrollment period ends Dec. 7, if you are enrolled in a Medicare Advantage plan, you can switch from to another Medicare Advantage plan or go back to Original Medicare if you’re unhappy with the plan you selected between Jan. 1 and March 31 of each year. This open enrollment period from January to March is available only to Medicare Advantage enrollees, which means you cannot change from Original Medicare to Medicare Advantage coverage.

If you miss Medicare’s open enrollment, you may be able to make changes to your coverage through a special enrollment period if you’re eligible. If you do not qualify for a special enrollment period, you’ll need to wait for the next annual enrollment or open enrollment period to make changes to your Medicare plan.

Dawn Maroney is president of Markets at Alignment Healthcare and CEO of Alignment Health Plan. Alignment Health is an award-winning Medicare Advantage company that offers HMO and PPO plan options in Arizona, California, Nevada and North Carolina with plans to expand in Texas and Florida in 2023.