Open Enrollment Period for Under 65: Everything You Need to Know About OEP

Open Enrollment Period for Under 65: Everything You Need to Know About OEP

Medicare Annual Enrollment Period AEP 2021 will be here before you realize it. Between 15th October and 7th December, you have the opportunity to adjust your Medicare Advantage and drug plans. The entire process aims to ensure you have the right plan to match your healthcare requirements in the upcoming year.

Why Review Your Medicare Coverage?

Whether you receive your benefits through Medicare Advantage (MA), Original Medicare, or Medicare Part D, it’s of your best interest that you review your alternatives during AEP. Here are the critical reasons for reviewing your Medicare choices during the period:

It Helps You Ascertain Whether Your Current Coverage Addresses All Your Healthcare Needs

If you’ve experienced a change in your health status and aren’t sure whether your current plan can meet your healthcare needs adequately, you can use this period to compare the options and the coverages they offer. These may include vision, prescription drug, dental, and hearing coverage.

Better Management of Your Out-of-Pocket Expenses

An agent can help you explore the alternatives for saving money. You will find the right plan, which offers additional flexibility in covering costs such as copayments, coinsurance, and deductibles.

To Determine Whether the Plan Covers Your Current Medications

Every year, the drugs that are highlighted in your plan’s formulary change. What’s more, the price for the respective medicines you take may vary from plan to plan since the plans negotiate discounts with pharmacies differently. The AEP period is appropriate for medication comparisons, and you are sure to get the right solutions for your needs.

To Ensure the Freedom to Visit Your Preferred Physician

You can use the AEP period to ascertain the right plan that allows you to work with your favorite specialists, doctors, pharmacies, and healthcare facilities.

Eligibility Factors for Medicare AEP

You are qualified for both Part A and Part B once you attain the age of 65. The critical eligibility factors include:

  • You must be a citizen of the United States or a legal permanent resident who has been in the country for five consecutive years.
  • If you’re married, one of the partners must have worked long enough to earn Railroad Retirement and Social Security benefits.
  • One of the spouses must be a government employee or retiree who has paid Medicare payroll taxes but not Social Security.

On the other hand, those below the age of 65 still qualify for this plan if they meet the following requirements:

  • You’ve been getting benefits like Social Security and certain Railroad Retirement Board disability benefits for not less than 24 months.
  • You have amyotrophic lateral sclerosis (ALS), otherwise known as Lou Gehrig’s disease.
  • You have End-Stage Renal Disease, and one marriage partner has paid Social Security taxes for a particular duration.
Medicare Enrollment Methods

You can enroll in Medicare in two ways; manually or automatically.

Automatic Enrollment

Automatic enrollment is for those who meet the above criteria. If you are 65 years old and are already earning your Railroad retirement and Social Security benefits, you automatically qualify. The same applies to those under 65 years but have received the same benefits for at least 24 calendar months.

If you meet these requirements, you’ll get your blue, white, and red Medicare benefits through the mail. Your coverage begins on the first day of your 65th birth-month, or the first day of the 25 the month of getting disability benefits.

Those under 65 and have Lou Gehrig’s disease or ALS will begin their Medicare benefits in the same month when their disability benefits will begin. You’ll not have to wait for the 24 months.

Manual Enrollment

If you are not automatically enrolled in Medicare, you can still leverage the manual alternative. If any of these circumstances apply to you, you are eligible for registration through this process:

  • Your 65th birthday should be around the corner.
  • You don’t receive Railroad Retirement Board and Social Security benefits.
  • You are below 65, but your ESRD condition qualifies you for Medicare.
  • You’re past 65 years old but have never enrolled in Medicare even after you reached the eligible age.

If you are a veteran, receive VA coverage, and meet all the Medicare eligibility requirements, you can also consider manually enrolling for Part A or Part B. With both the Medicare coverage and VA benefits, you have more care options and a more comprehensive coverage net. Even if you’re treated by a non-VA facility or doctor, Medicare Part A or Part B will still have covered your qualified care.

Preparing for the 2021 Medicare AEP

With such a short time left and a wide variety of options to review, you need the right insights on the practical approaches to take for an informed decision. While there’s no particular way to get the right plan, the following tips can help you choose what you need:

Evaluate Your Annual Notice of Change

Every year before the Annual Enrolment Period, members receive the Annual Notice of Change letter from carriers for Medicare Advantage and Medicare Part D Prescription Drug plan. This crucial document highlights the coverage offered by your current plan in the coming year. There may be significant adjustments, and the plan at hand may not be the right one for the new period.

Create A Checklist of the Things You Consider Important

Another best practice is to create a priority list to prevent you from being overwhelmed as you review the details of the available alternatives. It would help if you write out the features of your current coverage that appeal to you, and the areas that you feel need to be fixed. With a checklist before the due date, you will have a few excellent choices and eliminate the ineffective plans.

Here are some consideration factors when creating the checklist:

  • Benefits – Are the services you need covered in the plan? Do you require any referrals? Must you seek authorization to get any medication or healthcare services?
  • Cost – Does the plan offer a premium? What are the copays and deductibles? What’s the maximum limit for out-of-pocket? How much will all medications cost for the year?
  • Networks – Are you allowed to visit your preferred health facility or physician, or purchase drugs from whichever pharmacy? Are you still covered even when traveling?
Evaluate The Available Options

Once you have a glimpse of how the next year’s coverage will be and created a list of the essential items, it will be the right time to evaluate your alternatives. Which plan address all your needs? Have you seen a better option than the current one? As you assess your health insurance options, ensure you review both the Medicare Advantage and Medicare Supplement plans.

Choose The Best Coverage for You

It’s typical of people to wait until the end of the period to choose coverage, only to realize that they cannot get their preferred insurance cover. For example, if you want a Medicare Supplement plan, you may need several weeks to complete the application process. So if you wait till the eleventh hour of the AEP period, you may end up with a coverage level that you didn’t expect.

Signing up for your preferred coverage within the initial weeks will relieve you from the stress. By doing this, you’ll have the right time to make your decision and won’t feel pressured into going for an alternative just to get it off your plate. You’ll still have time to evaluate your options and adjust your coverage to match your needs in the coming period.

Shop Early

If you wish to change your Medicare supplement plan, ensure you shop early. Among the primary benefits of this plan is you don’t have to wait until the AEP to make adjustments. It’s still possible to apply for different letters or carriers throughout the year. So if you wait till the D-day, you should expect the longest approval time considering the massive number of applicants seeking to change from the Medicare Advantage plan during the period.

How to Get the Most of This Year’s AEP

To make the most out of this year’s AEP, you must focus on getting excellent coverage at the best price. Most people focus so much on finding the lowest premium, but this really isn’t the main objective. Your primary focus for the 2021 AEP is to keep your total out of pocket costs as low as possible.

When computing your healthcare expenses, premiums form only one component. You’ll also need to take care of copays, coinsurance, and deductibles. Avoid going for a particular plan just because it offers a low monthly premium. You may realize later on that the deductibles are relatively high. This mistake is common in both Part D drug plans and Medicare Advantage plans. So ensure you’ve learned all the costs before adjusting anything.

You must also review all aspects of Medicare Advantage plans. What is the coinsurance, deductible, monthly premium, and copays? It would also help if you understood the network of the plan. Medicare Advantage, for instance, is limited, and you can only see selected physicians. But this could benefit you in your own ways.

Work with A Reputable Agency

Are you looking for affordable health insurance plans for your health needs? Healthcare Solutions Team is home to top agents in the industries with all it takes to offer customer healthcare solutions to help you cut on costs and maximize coverage. Contact us today for more details about our services.