Joanne: It's that time of year again, the leaves are starting to change, and Joe Namath and company are interrupting your football-watching experience by yelling about the latest and greatest Medicare benefits. So this can only mean one thing, the Medicare annual election period is right around the corner. 

Cameron: But before we start, my name is Cameron Giardini and together with my co-host Joanne Giardini Russell, we operate Giardini Medicare. which is an independent insurance agency based out of Southeast Michigan. Although we are based in Michigan, we do work virtually over the phone to directly help consumers in about 13 states to find the right Medicare coverage for them.

If we do not work in your state, we will connect you with another trusted independent agent who will be able to help you find the coverage you want. We also have a free online course now available for you that you can register for to learn more about all sorts of Medicare topics. You can access the course by going to gmedcourse.com

So, a brief overview of today's episode, we will talk about when is the annual election period or AEP and what changes you can make during this time. We will talk about the advertisements Joanne already alluded to. We'll go over important documents for you to review during the annual election period.

What to consider if you have a Medigap plan or Medicare Advantage plan. As well as finish things off by talking about overall important changes to Medicare for 2024. So Joanne will kick it off with an overview of the annual election period. 

Joanne: Again we refer to this commonly as AEP, it occurs every year from October 15th until December 7th. If you make a change in your coverage during that time of year, your newly elected coverage will take effect on January 1st of the following year. Generally, the last plan that you enroll in is the one that's going to take effect the following year. Which can be good to remember if you do decide to change your mind during the AEP.

There's a special note here. The AEP, the annual election period, is designed for individuals who are already enrolled in Medicare to review and possibly change their current coverage. So this is not an enrollment period for people to enroll in Medicare Part A or B for the first time. This is also not a free-for-all time to get a Medigap plan without health questions being asked of you.

In most circumstances, in most states, you will still need to qualify for a Medigap plan based on your current health and your pre-existing conditions. Other notes and things to consider, if you have only original Medicare, which is Part A and B, during this annual election time, you can enroll in a Medicare Advantage plan or a prescription drug plan known as Part D coverage with or without a Medigap plan if you can qualify based on your health.

If you enroll in prescription coverage for the very first time, you however may be subject to a late enrollment penalty on the drug plan side of things. If you're enrolled in Medicare Advantage, you can switch to another Medicare Advantage plan with or without prescription drug coverage, or you can go back to Original Medicare with or without a Medigap plan and a Part D plan.

If you have Original Medicare, With Medigap and a Part D drug plan, you can change from one Part D drug plan to another Part D drug plan. Or you can enroll into a Medicare Advantage plan and you can disenroll from your Medigap and your Part D prescription coverage. You can also possibly change Medigap based on your current health status. So, there are lots of things going on during this time of year.

Cameron: Yeah, that's an overview. And like I said, we'll talk about each of those situations in more detail and something that Joanne also alluded to, but this is not a time if you need Medicare, you know, next year, or maybe you're eligible in the summer of 2024, or you're eligible in 2025.

Don't worry about AEP right now, make sure to reach out to somebody at the beginning of the year once all this craziness is over. But don't stress too much if you are eligible for Medicare six months from now or a year from now. This is really for people that are already on Medicare. But a reason that you normally want to reach out, even though you might be a year out from Medicare, is due to Medicare advertisements.

So, when it comes to Medicare advertisements, they are an inevitable part of turning 65 and becoming eligible for Medicare. As many of you know, we also create ads for social media and other sources. So although you can say we are part of the problem, we think there's a large difference between realistic ads that promote our services versus what you're actually seeing on TV and online during this annual election period.

We will even let you in on a little secret and let you know that you can Google "Facebook ads library". And then in that library, you can type in Medicare and you can see hundreds of ads targeting Medicare beneficiaries. Some are good and others are just. Blatantly misleading and harmful the main problem with much of the advertising is that they are cherry picking the richest benefits Only available in small parts of the country and they are advertising them to consumers nationwide They aren't doing this so you can learn what is out there But instead they are trying to get your hopes up so you will contact them or call an 800 number so that they can sell you a new plan that is actually available in your area or even sell your data or your name as a lead to other people.

So, fortunately, CMS, which is the Centers for Medicare and Medicaid Services, has begun cracking down and taking fairly drastic steps to limit misleading advertisements in recent years, which is due to a huge surge in consumer complaints. But we still really don't have much faith that the bad actors out there are actually going to follow these rules.

So prepare to see misleading advertisements for years to come. When it comes to Medicare overall, we recommend combating these advertisements by simply ignoring them. That's always the best way. And instead, just reach out to a trusted independent broker or even a ship counselor in your estate for third-party advice.

You can also listen to other episodes we have that tell you how to find plans that are actually available in your area to compare them to what is being presented in the ads you see. So to avoid some of the noise with advertisements, it's good to remember that a lot of the benefits you have with your plans and the changes with your plan, you will be able to find those by looking at plan documents.

And Joanne can go through those and just give you an idea of what you should be looking at when it comes to your and other coverages. 

Joanne: Right. So there are important documents that you really should be reviewing during the annual election time of year. The first document is called an annual notice of change.

We reference this as an ANOC. If you're enrolled in a Medicare Advantage plan or a Part D prescription coverage with an insurance company, the insurance company is obligated to send you an annual notice of change every year by September 30th. This notice essentially does exactly what it sounds like and it provides updates and details for important plan coverage changes for the upcoming year.

This includes changes to the plan, details such as premiums, deductibles, co-pays. This is a really good document to start your yearly review with since it will clearly show how your plan is going to change. The next document you want to pay attention to is what we call the Summary of Benefits. The Summary of Benefits is a document created by both Medicare Advantage and Part D insurance companies.

This summarizes the key features of the plan or the coverage, such as the covered benefits, the cost-sharing provisions, and the coverage limitations and exceptions. This document does not give you the full details about your plan coverage, but it's an excellent resource for understanding what your Medicare Advantage or Part D coverage does or does not cover.

You can request a copy of this document from your insurance company if you don't receive one, or you can typically find a copy in your online coverage portal. The last document we'll talk about is the evidence of coverage. The evidence of coverage is the document that contains the most detailed information about your Medicare Advantage or your Part D plan coverage.

Your EOC, evidence of coverage, is the legal contract between you and your Medicare plan, and it really explains how to use your plan's coverage. If you have specific questions about what your plan does or does not cover, the EOC should be where you can find that. And just like your annual notice of change, your plan should send you your evidence of coverage in September of every year, or you may have to find it online.

There's a special note too. If you have Medigap coverage, which is the Medicare supplement, you're not going to receive any of these documents related to your Medigap plan, only prescription drug plans and Medicare Advantage plans. 

Cameron: This is a very good point because a lot of people think that their Medigap is changing and they're missing that documentation when it just simply does not exist.

So if you're approaching the annual election period and you are currently enrolled in a Medicare Advantage plan, we're going to go through some of the things you can and can't do this time of year. So, quick disclaimer, these are not the only options, but they are generally, by far, the most common. Using an independent broker, like always, should make the process easier.

So the first situation is if you want to keep your current plan that you have. You can check your annual notice of change and other plan documents to see if your current Medicare Advantage plan still fits the coverage you want and, more importantly, the coverage you need. Remember Medicare Advantage plans, are yearly contracts.

So the coverage can and will change every year. These can be small changes or big changes. It might be co-pays or network changes or pharmacies, but it's always good to check. However, if you're happy with your current plan and it's still being offered for the following year, there's nothing you need to do.

And that coverage will renew. So if you like your Medicare Advantage plan, check to make sure it works for next year, sit back and it will renew with those new coverage details. for the upcoming year. If you want to change to a different Medicare Advantage plan, you can also do that. Make sure to do a full analysis, of course, of the new Medicare Advantage options.

This includes checking prescription coverage, provider networks, medical costs, extra benefits, and more. We do have another episode devoted to choosing Medicare Advantage, so make sure to listen to that. But if you find a new Medicare Advantage plan that you want to change to for the upcoming year, you can apply for that plan without health questions.

 Medicare Advantage plans are not permanent decisions. You can find a plan that will work for the next year and you don't have to overly stress about decades to come or longer than that because, again, these are yearly contracts. You're really just trying to find a plan to the best of your knowledge that will work for your upcoming healthcare needs.

Now, you still want to plan for potential worst-case scenarios but, again, just do what's realistically right for you. Now, the new enrollment cancels your current plan and your new Medicare Advantage plan would then begin on January 1st of the following year. And when I say it cancels your current plan, it doesn't cancel it until the end of the year.

So one cancels at the end of the year and the new one picks up on January 1st. And again, the big thing to reiterate here is to look at everything when it comes to the Medicare Advantage plan. Please don't get caught up in extra benefits or something flashy and change a plan only to realize the full package does not work for you.

Now lastly, if you want to change from a Medicare Advantage plan to a Medigap plan with or without adding Part D coverage, in most states you will still have to qualify for a new Medigap plan based on your health and pre-existing conditions. Even during the annual election period, this is why we don't like to call it open enrollment, like a lot of people, since you still have limits to what you can and can't do.

If you determine you want Medigap coverage, you will have to decide on a specific planned letter with a specific insurance company to actually apply for. First, you submit the application for the Medigap plan, and then if you are approved based on health and other conditions, you can enroll in Part D coverage, which is prescription coverage, and that will actually cancel your Medicare Advantage plan at the end of the year, and then your Medigap and Part D coverage can begin January 1st.

Do not enroll in Part D coverage until you know you are fully approved for the Medigap plan and apply early in the annual election period window. If possible, that means in mid October or November. Again, here, a big thing is to work with an independent broker that can compare Medigap plans and see which ones you might actually be eligible for based on health questions and those screening questions that we talked about.

But on the other side of the spectrum, what about if you have a Medigap plan going into the annual election period? 

Joanne: Well, let's talk about what you can and can't do in this case. So if you're going to keep your current coverage, now Medigap plans are lifetime contracts. So if you're happy with the coverage that you have, there's nothing you need to do to keep this Medigap plan for the upcoming year.

Part D plans, on the other hand, are yearly contracts, just like Medicare Advantage, and those coverages can and will change, and sometimes can change a lot, from one year to the next. However, if you run an analysis and you find that you want to keep your current Part D plan for next year, it's still available.

There's nothing that you need to do to keep it. It's just going to roll into the next year. Just remember, however, that the same plan with the same name will still have new coverage for the next year, whether it's new premiums, new deductibles, copays, etc. But the big thing to understand is that your Medigap Plan just rolls over and over and over until you elect to do something different with that plan if that day comes.

let's talk about if you want to change your Medigap plan and or your Part D coverage. So if you want to change Medigap or your Part D plan, these are separate decisions. You can change your Medigap without changing the Part D and vice versa. Most of the time, consumers use the annual election time to change their Part D coverage only since, remember, you can change Medigap coverage any time of the year as long as you qualify for a new plan.

So when it comes to Part D coverage, just run an analysis for the plans and find out which one has the lowest overall costs that work for your unique medications during the upcoming year. You can make this decision regardless of your Medigap coverage. If you do want to change Medigap during the annual election time, just note, that this is not a free-for-all to get into a plan without answering health questions, so you're still going to have to go through medical underwriting and it's typically going to take a bit longer during the annual election time because everybody's pretty busy and the carriers get backed up.

Now, if you have a Medigap plan and a drug plan and you decide that you want to change to a Medicare Advantage plan, this is also different. So if you want to change from Medigap to Medicare Advantage, annual election time is a good time to do this. You can change to a Medicare Advantage plan with no health questions asked of you.

However, know that this decision should not be made lightly. The reason being is that in most states and most circumstances, if you want to go back to a Medigap plan in the future, that opportunity is not guaranteed, and you'll likely have to qualify for a new Medigap plan based on your health at that time.

There is... Side note here, a special 12-month trial right that you may have access to if you have left a Medigap plan for a Medicare Advantage plan for the very first time. But beyond that, going back to Medigap may or may not be possible. So keep that in mind. We aren't saying don't change to a Medicare Advantage plan.

You'll have to go through a thorough analysis of the Medicare Advantage plan that you want to switch to and make sure that you're comfortable with that coverage long term just in case. Also, if you do enroll in a Medicare Advantage plan, it is going to cancel your Part D coverage, but you also will have the responsibility for canceling the Medigap coverage because it will not be canceled on your behalf.

Cameron: Yeah, it's not automatic like with the other things we talked about. So now we talked about what you can do if you have Medicare Advantage or a Medigap plan during this time of year. What about some of the overall changes coming to Medicare in 2024? So some of you may already be aware of these numbers, but we want to highlight all of them here.

first, the Medicare Part B premium, which is what you pay monthly to have Part B in the first place, is increasing from $164.90/month this year, up to $174.70/month for 2024. Along with that, the Part B deductible, which is what you pay out of pocket at the beginning of the year, typically for services is increasing from $226/year up to $240/year in 2024.

Now, this is only if you are getting a Part D penalty, but The calculation for that is increasing, and they're using $34.70/month as the base beneficiary premium, which is used to calculate the premium. Um, if that applies to you, you can always, you know, reach out with questions, but we don't want to stress too much about it.

Otherwise, with Part D, and as well as Medicare Advantage plans, the maximum prescription drug deductible for next year in 2024 is going up from $505/year up to $545/year. Again, that is the maximum, not every plan will have that deductible, but that's the highest limit it can be. Medicare Advantage plans that do have maximum out-of-pocket limits on their medical coverage, that limit will increase from $8,300 per year for in-network services up to $8,850 in 2024.

Again, that is the maximum limit, there are many plans that have lower maximums than that. Also, if you are curious about high deductible Medigap plans, that deductible is going from $2,700/year up to $2,800/year. And then last but not least, if you are a higher income individual and you are affected by IRMAA, which we have other episodes on, this does have a two-year look back, but somebody filing their taxes as a single person, the lower limit for Irma in 2024 is $103,000 per year.

So basically, if you make more than that from two years ago, you might be subject to IRMAA. Now, if you file a joint filing, that bottom limit for when you might be impacted by Irma is $206,000. Of course, you may be able to appeal that or reduce it, but we have other episodes about that, feel free to reach out to us if you have questions.

And then we'll finish things off with Joanne talking about some of the other impacts for 2024 and beyond.  

Joanne (2): Perhaps one of the biggest changes to Medicare coverage in 2024 is the change to Part D and Medicare Advantage, but it's the catastrophic coverage. Currently. The final phase of Part D coverage is called catastrophic coverage.

And we cover this coverage phase in much more detail in other episodes. But all you need to know here is that currently when you reach this catastrophic coverage phase in your drug plan or your Medicare Advantage plan, you are responsible for up to 5 percent of your medication costs. And there is no financial cap on what you will pay.

However, starting in 2024, if you reach a catastrophic coverage level, you will pay zero. for medications that are covered by your Part D plan. So, now there is finally a limit on prescription Part D plans. Now, the Kaiser Family Foundation estimates that Medicare beneficiaries will spend approximately $3,300, as we just discussed, out of pocket before reaching the catastrophic phase of coverage. Also, according to Kaiser, in 2019, there were 1.5 million beneficiaries that reached that catastrophic coverage threshold.

There are new changes to LIS, which is Low Income Subsidy Eligibility. Starting in 2024, individuals who are eligible for partial low-income subsidy will now be eligible instead for full low-income subsidy, which will increase their level of prescription drug cost assistance. Also starting in 2024, the Part D base beneficiary premium Won't be able to increase by more than 6 percent per year.

However, because this base premium is an average of many plans, it's important to remember that some individual Part D premiums can and still will increase by more than 6%. 

Cameron (2): Exactly. Yep. All good things to keep in mind. Some changes are starting in 2024, which is a little bit sooner than people think when they think of the cap for Part D starting in 2025.

So a brief recap, the annual election period, it's often a hectic time period in the world of Medicare, but with a little preparation and knowledge, we know that you will be able to navigate this enrollment period to find the right coverage for the upcoming year. Make sure you don't get caught up in advertising hype and you just take the time to compare plan options on your own or with a trusted independent broker.

As always, please leave us a review on your podcast app and subscribe so you can listen to future episodes. You can also find more Medicare content from us by going to YouTube and searching "Giardini Medicare". You can also do the same thing on TikTok. If you want to schedule a one-on-one phone call with one of our licensed agents, you can do so by going to gmedicareteam.com

Lastly, if you want to send us any feedback or questions about this episode or anything else, you can email us. and send it to info at gmedicareteam. com. So thank you, and have a great day.