Medicare open enrollment for calendar year 2024 opened on October 15, 2023, and continues through December 7. This is the one time of year that all Medicare beneficiaries can evaluate their options for how to receive their Medicare benefits—meaning it is a great time for LeadingAge members to ensure the older adults they serve get the best possible information regardless of the type of services they receive.

During open enrollment, Medicare beneficiaries can choose to enroll in their original Medicare, select their Part D Drug plan, choose a Medigap policy to wrap around their original Medicare or enroll in a Medicare Advantage (MA) or Special Needs Plan (SNP). Those already enrolled, can drop their current plans and enroll in a different plan or return to original Medicare if previously in an MA plan. Some beneficiaries mistakenly believe they must choose a plan during this time. While most should be enrolled in a Part D Drug plan, they are not required to also enroll in an MA/SNP plan.

As of 2023, more than 51% of Medicare beneficiaries have opted to enroll in an MA or SNP plan. Given that many MA enrollees have incomes below $25,000 per year, it is understandable that some find MA plans attractive given that 99% of beneficiaries have access to a $0 premium plan, out-of-pocket costs like co-insurance and co-payments are limited under an MA/SNP plan, and roughly 98% of MA/SNP plans offer supplemental benefits like hearing, vision and dental care that is not available via original Medicare.

What beneficiaries often don’t know that LeadingAge providers do, is what happens when someone needs skilled nursing facility care or home health services after a hospitalization, such as required prior authorizations, shorter lengths of stay in SNF, or fewer home health visits and sometimes MA plans wrongfully deny care for Medicare-covered services.  CMS has finalized some new rules that will take effect on January 1, 2024, that will hopefully mitigate these issues, but beneficiaries need to understand the effects of their options.

Providers under the Medicare Advantage regulations are permitted to connect beneficiaries with unbiased sources like the State Health Insurance Assistance Programs or point them to resources like the Medicare Plan Finder and the 2024 Medicare & You Handbook, which explains how original Medicare and Medicare Advantage compare to each other.  Providers can also share information with beneficiaries about which MA/SNP plans they are contracted or in-network with and answer questions about the merits of a plan. While providers cannot market for the MA/SNP plans or be compensated for marketing or enrollment activities for the plan, they can point beneficiaries to MA/SNP plan market materials made available in a common area.

Open enrollment is a great time of year for LeadingAge providers to make sure those they serve get good information about their Medicare options regardless of setting. Most beneficiaries and their families will appreciate the help in sifting through all the marketing materials they receive.