Heads up: Medicare open enrollment is just around the corner

Dear Kyle & Alan:

This time last year, I was on a Medicare Advantage plan through United Healthcare (UHC). As you well know, UHC withdrew its plan and did not renew for 2025.

That left me with a choice of Kaiser, Anthem Blue Cross or Aetna. Since I wanted a PPO plan, my choices were either Aetna or Anthem Blue Cross. I chose Aetna because they had a zero-premium plan.

My worry right now is that my Aetna plan may go away because it is too good! Do you have any knowledge about what's coming for those of us on an Advantage plan?

Tim

Kyle: The short answer, Tim, is no. Advantage plans and prescription drug plans are federal and are managed by the Centers for Medicare & Medicaid Services (CMS). As agents certified to sell these plans, we usually have no idea what will be available or at what cost.

Al: Each year about this time we have to complete the AHIP course (formerly America's Health Insurance Plans) and then get re-certified with every company that has a plan we can sell.

I can tell you that for next year's drug plans, the deductible will be $615 and the maximum out-of-pocket will be $2,100.

As for the rates and details of the upcoming Annual Enrollment Period, we probably won't get those until Oct. 1. You already know that the Annual Enrollment Period goes from Oct. 15 to Dec. 7.

Tim, you have an MAPD which simply means your Medicare plan covers the prescription drug benefit so you don't have to shop for a new one.

Kyle: If Aetna does not renew, you have the same options you did last year during the Annual Enrollment Period: you can look for another company's Advantage PPO plan or you can enroll in a Medicare Supplement plan.

The Preferred Provider Organization (PPO) may not be available because it opens up so many more providers than a Health Maintenance Organization (HMO) typically does.

If your Aetna plan simply bails on our area, like UHC did last year, you have a guaranteed issue scenario if you choose to enroll in a Medicare Supplement plan. That means you do not have to answer any health questions on the application because your plan left you!

Al: A Medicare Supplement plan means you can go to any doctor that accepts Medicare. Also, it works anywhere in the United States. However, there are drawbacks.

First, the Supplement is going to cost a lot more than a zero-premium Advantage plan. The price depends on age, location and the rates set by the insurance companies.

Second, a drug plan is not included with the Supplement. There is a separate charge depending on which of the many plans is chosen.

Kyle: So, Tim, we won't know about the 2026 Advantage plans until after Oct. 1, and we can't do the paperwork until Oct. 15. We'll keep you posted!