By Jocelyne Smith, Grace Cottage Patient Resource Advocate
It’s that time of year! Medicare open enrollment starts October 15th and runs through Dec 7th.
This year, there are some exciting changes, thanks to the Inflation Reduction Act.
Perhaps most important, the Medicare Donut Hole will be gone! They’ve said this before because there were gradual changes, but this year you will see the benefits of these changes.
Also important, there will be a $2,000 cap on medications. This means you will not pay more than $2,000 in a benefit year. Deductibles will have a slight increase, but in 2025, those of you on high-cost medications will have the option of entering into a payment plan to lessen the blow in the beginning of the year. So, keep in mind the option of a payment plan and a $2,000 cap on out-of-pocket cost for drugs.
It’s still important to review your drug plans (Part D) for the following year to be sure it still works for you, your meds, your pharmacy etc. There are programs out there through Social Security and the State of Vermont (Green Mountain Care) that can drastically reduce your out-of-pocket for Medicare drug costs. Many people are surprised at the income thresholds for these programs vs Medicaid.
If you are struggling with the costs, feel free to reach out; in most cases a phone call is enough to determine eligibility and decide whether you’d like to apply. I am happy to help anyone in the community with reviewing drugs plans or even if you just have general questions about the differences between Advantage vs Supplements.
Be aware of phone calls, mailings, etc. telling you to “act now.” This is often a tactic to get you to call in to a carrier and be talked into changing plans. NEVER give personal info over the phone unless you know you are talking to a legitimate representative of a real insurance company, and you are sure that you are making an educated decision to enroll in a different plan.
Another step of caution is to review your Explanation of Benefits (EOBs) or Medicare Summary Notices (MSNs) to make sure that you have in fact seen the doctors who are listed and that the medications listed are your meds. This is the best way to protect yourself from Medicare Fraud.
For those who are not yet 65 and need to consider health insurance through the Vermont Health Connect Marketplace, November 1st through January 15th is Vermont Health Connect’s (VHC) open enrollment. There will be some changes to these plans as well, such as phasing out the lower Cost Sharing Reduction plans. The new Plan Comparison Tool will be updated starting October 15th; this is the best way to review 2025 plans/subsidies based on your household size and income. It’s important that you pay attention to notices from both VHC and the Carrier (BCBS or MVP).
I am licensed with VHC and can assist with this as well. If you need help finding the right insurance for you, please reach out to me at 802-365-3770.
