Joanne: The fall Medicare Annual Election Period is upon us, so to avoid the chaos and help you understand what you actually need to be aware of, we wanted to bring you this podcast episode. We’ll discuss what you should know and do, whether you have a Medicare Advantage plan or Medigap coverage.

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 in southeast Michigan. Although we are based in Michigan, we work virtually over the phone to directly help consumers in about 15 different states find the right Medicare coverage for them. If we do not work in your state, we’ll connect you with another trusted independent agent who can help you find the coverage you need.

Last but not least, we also have a free online course available for you to register for, and you can do that by going to gmedcourse.com.

Joanne: Let’s do an overview of today’s episode. So, remember, this is a brief reminder of when the Annual Election Period actually is and what it’s for. And just to clarify, this is not for people enrolling in Medicare for the first time. Then we’ll talk about what you should know if you have a Medicare Advantage plan and what you should know if you have Medigap and Part D, which is prescription drug coverage. And at the end, we’ll give you our key takeaways.

Cameron: Yeah, we go over this every year because, without fail, these questions always come up. So again, it’s never a bad thing to rehash what you can and can’t do during this time of year. The Medicare Annual Election Period, often shortened to AEP, takes place every year from October 15th until December 7th. Now, we say this every year, but it’s important to repeat: while this period is often called "open enrollment" by the media or even online on Medicare.gov, it doesn’t mean you can make any change you want without restrictions. For example, if you’re thinking about switching to a new Medicare Supplement plan or Medigap plan, there’s a common misconception that the AEP is the time to do so.

But here’s the catch: most of the time, you’ll have to qualify for the new Medigap plan by answering health questions. This process is called medical underwriting, as we’ve talked about in the past. It allows insurance companies to review your health history and decide whether to accept or deny your Medigap application. So yes, even during the fall Annual Election Period, you could be denied Medigap coverage based on your health, and this will depend somewhat on the state you live in.

However, here are some things you *can* do during the Annual Election Period. You can switch from Original Medicare with Medigap coverage to a Medicare Advantage plan. You can switch from one Medicare Advantage plan to another, and that does not require health questions. You can switch from Medicare Advantage back to Original Medicare and add Part D coverage. You can also add Medigap coverage to that, again, if you can qualify based on your health. You can also keep your Medigap coverage the same but change your Part D prescription drug coverage. And lastly, if you currently have only Original Medicare, you can apply for a Medicare Advantage plan or Medigap plan with underwriting for Medigap. So, there are plenty of things you can do during this time period, but just remember, it’s not a free-for-all. Now, let’s shift and talk about what you can do specifically with Medicare Advantage.

Joanne: Despite what you might hear online or on social media, the vast majority of Medicare Advantage enrollees are happy with their plans and plan to stick with them. But the question we often hear is, "If I like my plan, do I need to do anything?" The short answer is yes. Even if you’re happy with your current Medicare Advantage plan and want to keep it for next year, it’s still important to review your options, typically with a broker, just to make sure it’s still the right fit for you. The main reason is that Medicare Advantage plans are annual contracts. Your coverage is only set for the calendar year, from January 1st to December 31st. This means your plan can, and almost certainly will, change every year.

Now, these changes might include adjustments to premiums, deductibles, or copays. For example, a specialist copay could go from $30 to $40. Your prescription coverage or medications might move to a different tier, or the plan could change the extra benefits, like dental coverage. Even if your dental coverage stays the same, the dental network provider might change. So, while your plan may continue with the same name and ID number, that doesn’t mean your coverage will stay the same. You’ll likely be able to keep your plan, but the details will change. However, we don’t say this to scare you. In most cases, these yearly changes are pretty minor. We just encourage you to be proactive and take 15 to 30 minutes every year to review your plan and make sure it still fits your needs.

Cameron: What are the steps you can take to actually review your plan? First, check your Annual Notice of Change. You will receive this from your plan, either in the mail or online, through your plan’s member portal. It depends on how you chose to receive information from your plan. This Annual Notice of Change, or ANOC for short, highlights the key changes in your plan for the upcoming year, including premium changes and coverage updates. It’s a good starting point to see what’s changing, but don’t rely on that alone to decide your coverage for 2025. We recommend a couple of additional steps as well. One is to check your prescription coverage using the Medicare.gov Plan Finder tool. We have a video on our YouTube channel that walks you through how to do that analysis. You can find it by searching Giardini Medicare on YouTube.

In the video, we talk about doing a Part D analysis, but the process is basically the same for Medicare Advantage plans with prescription drug coverage. The most important thing is to make sure your medications will be well-covered for 2025 with whatever plan you choose. Next, for more information, you can go through your plan’s Summary of Benefits document. This document gives you a more detailed breakdown of costs for the services your plan offers next year. This goes far beyond what’s shown in the Annual Notice of Change. If after reviewing these documents, you’re happy with your plan’s coverage for the next year, you don’t have to do anything. Your plan will automatically renew for 2025. But if you do want to compare your plan to others or make a change, we suggest reaching out to an independent broker licensed in your area. We’ll provide a link in the show notes so you can connect with us or another licensed professional.

Finally, keep in mind that in some states, there will be bigger disruptions than others. Some plans are being terminated entirely for 2025. For example, Humana is exiting 13 markets across the country, affecting around 560,000 members who will have to find new coverage. This is according to an article from Newsweek. In that case, what can you do if your plan is being terminated and is no longer offered?

Cameron: First, don’t panic. You almost certainly have options. In fact, for some people, this could even be good news. If your Medicare Advantage plan is no longer available in your county, you would have the opportunity to get a Medigap plan using guaranteed issue rights. This means no medical underwriting or exclusions for pre-existing conditions, and you would have a handful of Medigap plans to choose from.

If you prefer to stick with a Medicare Advantage plan and your current one is being terminated, you will need to check if your current company, which is terminating the plan, will offer a different Medicare Advantage plan for next year. If not, you can always look at other insurance companies that offer Medicare Advantage plans in your area for 2025. Again, the easiest way to see all of the available plans is by using the Medicare.gov Plan Finder tool. Keep in mind, if your plan is being terminated and you don’t do anything, you will be left with only Original Medicare coverage starting January 1st, 2025.

Now, if you want to switch from Medicare Advantage to Medigap and Part D, but your plan is not being terminated and you don’t qualify for guaranteed issue rights, you can still apply for Medigap coverage, effective January 1st, during the Annual Election Period. However, as I mentioned at the beginning, you’ll need to answer health questions for this, and if your application is denied, you can simply remain with your current Medicare Advantage plan for the upcoming year.

On the flip side, if your Medigap application is approved and you want to switch to Medigap coverage on January 1st, you would need to enroll in a standalone Part D plan between October 15th and December 7th. The Part D coverage would start January 1st, and it would automatically cancel your current Medicare Advantage plan at the end of the year, allowing you to smoothly transition to Medigap and Part D coverage.

Joanne: Just a quick aside here: It’s extremely important that you only enroll in the Part D prescription drug plan after you’ve been approved for your Medigap policy, as Cameron mentioned. If you enroll in a Part D plan before you’re approved for Medigap, you could end up canceling your Medicare Advantage plan, leaving you with no coverage. So, please take extra precaution here.

Cameron: Yeah, you can avoid most of these hassles just by working with a broker who can walk you through the steps. That’s advice for the do-it-yourselfers out there.

Joanne: So, what do you do if you have a Medigap plan plus a Part D plan? If you have those coverages, the most important thing to know during the Annual Election Period is that Medigap is a lifetime contract. This means as long as you pay your premiums, your coverage will continue, and you don’t need to do anything to actively renew it each year. Another key point is that you can try to change your Medigap plan any time of the year, not just during the Annual Election Period. But remember, *try* is the key word here because you’ll likely have to go through medical underwriting, and approval will depend on your health. If possible, try to avoid changing your Medigap plan during the Annual Election Period, which, again, runs from October 15th to December 7th.

The reason being, brokers and insurance companies are extremely busy during this time of year, and the process could take longer. While you technically can switch during this time, it’s better to do so before October or after December 7th if you can.

Now, for those of you with Medigap and Part D coverage, the Annual Election Period is mostly about changing your Part D coverage. Just like Medicare Advantage, Part D plans are annual contracts, and your coverage changes every January 1st. So, make sure to review your Annual Notice of Change, and use the Plan Finder tool on Medicare.gov to review your Part D coverage for the following year. Even if your medications stay the same, your plan’s premium, deductible, co-pays, and formulary—the list of covered medications—could change for 2025. So, it’s worth taking some time to check your Part D plan for next year.

Cameron: Yeah, that’s super important because we always get questions from people saying, “Hey, I’m taking the same medications and nothing’s changed on my end. Do I need to do anything for next year?” The answer is always yes. You still need to review your coverage.

Another thing to watch out for when it comes to Part D plans is something called "crosswalking." This is an insurance term that means an insurance company is going to move you to a different Part D plan they offer, whether you want the change or not. For example, let’s say an insurance company offers three plans in 2024—Plan A, which costs $10 per month; Plan B, which costs $40 per month; and Plan C, which costs $100 per month. Now, the company might decide to stop offering Plan A for 2025. In this case, they can "crosswalk" the members from Plan A to Plan B for 2025. This means if you don’t take any action, your coverage will automatically shift to Plan B, resulting in higher premiums and possibly different coverage, whether you want the change or not. Plan A will simply end.

We won’t go into the specifics in this episode, but it’s important to know that some Part D plans are being crosswalked for 2025, and others are being terminated entirely. This is why it’s crucial to double-check your options, even if you’re happy with your current plan.

Once you’ve done your Part D analysis, if your plan is still available and you’re satisfied with it, you don’t need to do anything during the Annual Election Period. Your Part D coverage will automatically renew with the updated 2025 coverage details outlined in your Annual Notice of Change. But if you find a better option for 2025, you can enroll in a new Part D plan between October 15th and December 7th, and the new plan will take effect on January 1st, automatically canceling your current plan. Just remember, changing your Part D coverage has no impact on your Medigap coverage, so you can make these adjustments without worry.

Joanne: A few extra points here. If you currently have Medigap and Part D coverage, but after learning more about Medicare Advantage, you decide you want to switch to a Medicare Advantage plan for the following year, you can do that during the Annual Election Period without any health questions or medical underwriting. Once you’ve chosen a Medicare Advantage plan, you’ll simply apply for that plan with the help of a broker during the October 15th to December 7th time frame, and the new plan will take effect on January 1st.

Now, keep in mind that enrolling in a Medicare Advantage plan will automatically cancel your Part D drug plan at the end of the year, but it will not automatically cancel your Medigap plan. To cancel your Medigap coverage, you’ll need to call or submit a written cancellation request to the insurance company effective at the end of December.

Also, if this is your first time switching from Medigap to Medicare Advantage, remember that you have a 12-month trial period. This means you can return to your previous Medigap plan with guaranteed issue rights if the Medicare Advantage plan you chose doesn’t work out for you. Make sure to mark your calendar to do that within the 12-month time frame.

Cameron: As for takeaways from this episode, first, make sure to do a coverage review every year. Even if you’re happy with your current plan, you’ll always want to take these steps. You don’t have to spend all your time searching for every single plan on the market, but at least review your Annual Notice of Change, your plan’s Summary of Benefits, and even the Evidence of Coverage document, which is the most detailed document they provide. Compare what your plan will look like next year with other options, just for peace of mind.

If your current coverage is being discontinued for next year, don’t worry. The process is the same—just connect with an independent broker who can help you compare and choose the right option for you. Above all, don’t get caught up in the marketing hype. Some of you may face significant changes to your coverage heading into 2025, but for most, the changes will be minor, just like in past years.

During this time of year, you’ll see a flood of advertisements from brokers and insurance companies telling you that you’re missing out on extra benefits or loads of other things. But remember, this happens every year. A quick annual review will not only help you make the right coverage decision for 2025, but more importantly, it will give you peace of mind.

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 or TikTok and searching "Giardini Medicare." Lastly, if you have any feedback or questions, you can send us an email at info@gmedicareteam.com, or go to our website to schedule an appointment with us at gmedicareteam.com. Thank you, and have a great day.