Allison Schneider (00:00):

That's what I would say is very risky. Medicare open enrollment offers you the chance to do a few different things. You can switch from original Medicare to Medicare Advantage. You can change the type of plan you're in. You can change the prescription drug plan you're in. But once we're into 2027, for the most part, it is difficult to change your coverage. So you won't want to wait until a health condition worsens to choose what coverage is most appropriate for you.

Intro (00:32):

Welcome to BrainStorm by UsAgainstAlzheimer's, a patient-centered nonprofit organization. Your host, Meryl Comer, is a co-founder, 24-year caregiver, and Emmy Award-winning journalist, and the author of the New York Times bestseller, Slow Dancing with a Stranger.

Meryl Comer (00:51):

This is Brainstorm and I'm Meryl Comer. Today's conversation focuses on something that millions of families put off, dread, or assume they already understand. We're talking about the Medicare open enrollment window that runs from October 15th through December 7th with most changes taking effect January 1st. My guest today is Alison Schneider, Director of Market Access Policy and Strategy at AbbVie Health. Before joining AbbVie, she served in public health policy and operations of the Centers for Disease Control and Prevention. Allison, welcome. Thank you for joining us.

Allison Schneider (01:36):

Hi, Meryl. Good to be here today.

Meryl Comer (01:39):

Allison, when families hear Medicare open enrollment, many of us think of it as simply a paperwork exercise. What's actually at stake?

Allison Schneider (01:50):

That's a great question. I think that's a common viewpoint, but this is really the opportunity for current Medicare enrollees or their family members to make sure that the plan, or option in Medicare that the beneficiary enrolled in is, is what's right for them. And that can include a lot of different things. That can include the doctors that you see. Are you going to still have access to those doctors next year? The cost sharing that you pay. What are your, what are your out-of-pocket costs going to look like next year? So even if you think you might want to stay in the same plan, if you're in Medicare Advantage, this is still a really good opportunity to make sure that that's still the best option for you.

Meryl Comer (02:34):

So Alison, let's run through a series of issues that are potentially the most expensive mistakes people make during open enrollment. So I'll give you a statement, you tell us whether it's wise, risky, incomplete.

Allison Schneider (02:50):

Let's do it.

Meryl Comer (02:53):

You ready? <Laugh> Oh, Alison, my plan worked yesterday, yes - last year, so I don't need to look at it.

Allison Schneider (03:00):

I would say that is risky. There's a few different things to think about when you're in the open enrollment period. So you may be enrolled in original Medicare already, and you'll want to make sure that you want to maintain that enrollment, that it's still working for you. If you're in a Medicare Advantage plan, kind of similar dynamic here, do you want to keep that plan or do you want to change it? Plans can make changes from year to year, so what your coverage looks like right now could change next year and your plan may not be offering the same benefits. So even if you were satisfied this year, I would say it's risky not to look at what other options are available to you before the next plan year.

Meryl Comer (03:44):

A lot of families, Alison, are under great tension, because of inflation, high cost of living. So this is a statement they may make, "The lowest monthly premium is the best deal."

Allison Schneider (03:59):

You know, I think my answer for a lot of these might be risky. I'm going to say that again. There's a lot of different things to think about when you're thinking of what are my costs going to look like in Medicare? If you're in a Medicare Advantage plan, you do have to think about your premium, but there are also other types of costs that you could be subject to. That includes a deductible, so an amount that you'll have to pay out of pocket before your plan starts, helping pay for services, as well as cost sharing for individual doctor's visits, or if you're taking prescription drugs every time you fill a prescription. So all of those are things that you want to think about when you're thinking of what is my total cost going to look like for the next year? And sometimes the lowest premium plan may have higher cost sharing for some of those other areas that I talked about and it end up, it may end up actually being more expensive.

Meryl Comer (04:56):

So assumptions are dangerous. My doctor accepts Medicare. So the notion is, will they be in my Medicare Advantage plans network?

Allison Schneider (05:06):

Another one that is risky.  If your doctor accepts Medicare and you are in original Medicare, then your doctor should be able to provide you care. If you are in Medicare Advantage, that comes with a network. So not all doctors will be included in every Medicare Advantage plans network. And that's something that's really important to confirm hasn't changed between this year and next year. If your doctor is in your current plans network, you'll want to confirm that's still the case before remaining in that

Meryl Comer (05:41):

Plan. What about my prescription was covered last year, so it's going to be covered the same way next year?

Allison Schneider (05:48):

Another one that I would say is risky. -

Meryl Comer (05:51):

How about expensive? <Laugh>

Allison Schneider (05:53):

You know, all of the above. Your prescription drug coverage can change. Depending on the type of drug that we're talking about, there are coverage requirements for prescription drug plans that are offered by insurers. So some of that may still remain covered, but it may not be covered in the same way. And that could include a, a few different things. That could be the amount that you pay every time you fill a prescription, that could increase from year to year, the pharmacies that are in network. So where do you like to receive your prescriptions if these are drugs that you take at home? , And if there's any kind of what's called utilization management. So do you have to get, additional approval before you are able to obtain that prescription? , So you want to make sure that your costs are the same or lower or, that you're still able to access your prescriptions at the places that's most convenient to you.

Meryl Comer (06:50):

Now, sometimes, Alison, the extras get very attractive, extra dental, vision, gym benefits. That's what's going to drive my decision. What's right or wrong about that?

Allison Schneider (07:03):

You know, I would say this one is maybe incomplete. Those are benefits that you should consider and can be very helpful, especially the dental and vision, which is not included in original Medicare. But I would be careful about looking at those as kind of your deciding factor when you're picking a Medicare Advantage plan. You want to look at sort of the core coverage first. So what is the coverage, what is the cost sharing for hospital services, for doctor's visits, for prescription drugs, and make sure all of that is aligned with what you need. And if that supplemental, those supplemental services like hearing, vision, dental are still of interest to you, then look at the plans that are left that have met your other kind of criteria for those core services. A lot of plans offer supplemental benefits, so I would not use that as kind of a deciding factor when you're choosing coverage.

Meryl Comer (08:00):

What about the notion that, well, I can always switch to any coverage arrangement later if my health changes? Because That's hard to predict, right?

Allison Schneider (08:10):

That's what I would say is very risky. Medicare open enrollment offers you the chance to do a few different things. You can switch from original Medicare to Medicare Advantage. You can change the type of plan you're in. You can change the prescription drug plan you're in. But once we're into 2027, for the most part, it is difficult to change your coverage. There are very se - special circumstances that may allow you to do so, but for most beneficiaries that is not going to be possible. So you won't want to wait until a health condition worsens, to choose what coverage is most appropriate for you. You're going to want to make sure that you have that coverage in place before going into 2027.

Meryl Comer (08:55):

So for those who are in their late 70s, 80s, the attitude, "My adult child should make this decision for me." What's tricky about that?

Allison Schneider (09:09):

I would say as much as possible, you want to be aware of what care you're going to be accessing and how that's going to impact your expenses. If a family member is heavily involved in helping you make those decisions, then it's equally important for them to be aware of what your costs will be, what kind of doctors you'll be able to visit, and which plan makes the most sense for you, including, you know, taking into account that you won't be able to make changes to those decisions likely next year, and you wouldn't be able to do so until 2028. So education is, is really the biggest, I think of highest importance for whoever is helping you make those decisions. And there are a range of different resources, that beneficiaries and their family members can access to learn more about the different options available to them.

Meryl Comer (10:02):

So those 65 plus don't like to be told by their kids what to do. <Laugh> But, but what do adult children of Medicare recipients often fail to appreciate until there is a health crisis, a hospitalization, a cognitive concern, or the need for specialty care?

Allison Schneider (10:23):

I think having an understanding of what's covered under different parts of Medicare and what those costs can look like. And a lot of this information can be found in the Medicare and, and you handbook is a really great resource. There are also different resources available online, but understanding, if you're in original Medicare, what does your out-of-pocket cost look like? There is not a cap on how much you can pay in original Medicare in a given year. So if there is a significant health change for someone in your family that's on Medicare, that could have really s - a really significant impact on your family. That being said, when you're thinking about Medicare Advantage, there is a kind of cap on how much you can pay in a given year, but that comes with some trade-offs. There are limitations to what providers you can see.

Allison Schneider (11:16):

You have to get prior authorization from your plan if you want to see a, a given specialist or for prescription drugs or, or different types of services, which can also be a hassle for families. So you'll want to understand those different dynamics ahead of time before you're in a situation next year where you're not able to make changes to your plan.

Meryl Comer (11:38):

So let's change our conversation. Should we be thinking about what could change next year that would make the plan that we're in no longer work for us? It's hard to anticipate illness, but it's trying to project what we need to know, right?

Allison Schneider (11:59):

I would go into it with the mindset of you want to have comprehensive coverage, even if right now you're not accessing a lot of prescription drugs or you don't need hospital coverage, you want to have that, available to you going into next year. So kind of going back to what we were talking about with the lowest premium plan, something that often comes with those plans is they don't have the most comprehen- comprehensive coverage and they have a lot higher cost sharing for those types of services. And that's something you'll want to keep in mind when you're deciding whether or not to, to stay in a plan like that this year.

Meryl Comer (12:38):

Is one of the biggest mistakes focusing too heavily on the monthly premium while ignoring deductibles, copays, co-insurance, and that maximum out-of-pocket exposure?

Allison Schneider (12:52):

I think it can be. That's just one aspect of what you're going to pay. And if you don't need to access a lot of Medicare medical care in a given year, then a low premium plan can be great. But if you want comprehensive coverage and you want that in place in case your health changes, then that may not be the best plan for you.

Meryl Comer (13:12):

So I mentioned all the extras that we like, dental, vision, hearing, transportation, meals, benefit, fitness programs, but how do consumers or how should we weigh those features against access to physicians, hospitals, specialists and medication?

Allison Schneider (13:32):

I would weigh those as kind of as they're described, they're supplemental benefits, they're add-ons to your care, but they are not your care. So really looking at, do you have access to the doctor that you like to see? Is your prescription drug cost going to stay the same next year? Those should be the primary considerations that you're taking into account when you're choosing a plan. And then looking at those supplemental benefits as, you know, something extra that you get. And also really looking into what those supplemental benefits are, because they can vary quite a bit. Some of them are, you know, if we're talking about dental care, they cover dental cleanings, but they don't go anywhere beyond that, whereas others are, are more comprehensive and they do provide more coverage. But if you're looking at something that doesn't provide as much from a supplemental basis, that may be less of a, less of a factor in, in what's going to help you next year.

Meryl Comer (14:28):

Now, CMS, specifically advises beneficiaries, and I just reviewed my policy <laugh> so I know, that these plan materials for changes that could affect next year coverage. So what should we be looking for in the annual notice of change and the evidence of coverage?

Allison Schneider (14:50):

Yes. I'm so glad you brought that up. So beneficiaries should have gotten that in September, their annual notice of change, and that will outline key changes that will be made to your plan next year. That includes changes to costs, changes to networks, so what doctors you're able to see, what other types of providers you're able to see. And then when we're looking at prescription drug coverage, what drugs are included on formulary, what is the cost sharing for those drugs, and if there are any that require prior authorization or additional steps that you may have to go through before accessing that prescription. So that's a really, really key document when you're thinking about, do I need to make a change this year for my coverage, really reviewing that in depth and understanding if, if there are changes to your costs that are going to be happening, even more so in that instance, it makes sense to take advantage of this time during open enrollment to look at what other options are available to you that may maintain some of the coverage that you may have lost from this year if your plan is changing.

Meryl Comer (15:58):

So how can we verify and just not assume that our actual doctors, hospitals, preferred pharmacies, medications are covered under the specific plans we're considering?

Allison Schneider (16:13):

There are a few resources that I would call out when you're thinking about how to compare coverage and decide if you need to change plans. So one that you can use, just from your own home with a computer is called Medicare Plan Finder or Plan Compare. This is an online tool. You put in your zip code and it allows you to look at all of the different types of plans that are available to you. You can put in your specific prescriptions that you're taking. There are specific pharmacies that you use. You can see if those are in network for different types of plans. You can see if the cost sharing is different between plans, and you can also search for specific doctors and new this year, they've also added additional types of healthcare providers that you can search in addition to physicians to see if those are in network of the plans that you're comparing.

Allison Schneider (17:08):

I would also highlight there are a few other, resources available to Medicare beneficiaries and their families. At the state level, there are state health insurance assistance programs. If you look that up online with the state name, you can get the contact information, for those programs. And those are people that can help you navigate whether or not you want to change coverage or if there are different options available to you. And then there's also just the option to call someone at Medicare or chat with them and, and they can also help answer questions that you may have after going through the, the different resources available to you.

Meryl Comer (17:47):

Are they picking up the phone more often now than they have in the past?

Allison Schneider (17:51):

I hope so. Because this is the time to do it.

Meryl Comer (17:56):

, Alison, for families dealing with dementia, Parkinson's, stroke recovery, cancer, diabetes, or multiple chronic conditions, what additional due j - diligence is really essential?

Allison Schneider (18:12):

I would make sure in addition to everything that we've talked about, you're aware of the different programs available to beneficiaries to help with costs. There are programs available to help with your medical costs as well as your drug costs. And some of those you may automatically apply for. Some of them you can apply for and you may be eligible based on your income. That can help reduce how much you're paying for prescription drugs every year. Can also help with paying, your premiums month to month. So that can be a, an assist. And those are available. I would, harken back to those resources I just mentioned in terms of if you need to apply for them, how to do that. But I think some people are eligible for these financial assistance programs and they may not even know it. So making sure that you're aware of that.

Allison Schneider (19:06):

, There's also a relatively new program in, Medicare Part D, which is what covers your prescription drugs that you would get at a pharmacy that allows you to spread out the cost of those prescriptions over the course of the year. So it doesn't lower the cost of what you're paying for your prescription drugs, but if you are on higher cost medications, like are more common in the disease areas that we're talking about, you're able to pay for those over a 12 month period instead of all at once, which can also help patients and families.

Meryl Comer (19:41):

With the longevity curve extending, 65 is young. So tell me what the first time 65ers should be thinking about when it comes to Medicare. The same things we've discussed or...

Allison Schneider (19:58):

I think a lot of the same things we've discussed. I think maybe even more important for people that are enrolling in Medicare for the first time is deciding if what's called original Medicare is right for you or Medicare Advantage, which is a lot of what we've been talking about in terms of comparing plans online. Medicare Advantage is administered by private insurers that contract with the government, but there are differences in terms of how the two are administered. One that we already talked about for original Medicare, there's not really a network of providers. You know, if your doctor participates in Medicare, you're able to receive care from them, which is not the case with Medicare Advantage. That being said, Medicare Advantage usually does a better job of copping, capping your, out-of-pocket costs for the year compared to original Medicare. Once people are, are in Medicare, like we've been talking about, they tend to stay in the kind of program that they're in, although you should always check it at open enrollment if that's the right program for you.

Allison Schneider (21:03):

But I think when you're newly enrolling in the program is a really good opportunity to decide sort of what type of Medicare makes the most sense for you to enroll in.

Meryl Comer (21:13):

I'm sure groups like yours have done a lot of studies on the intergenerational angst when it comes to doing this. <Laugh> You're smiling, so there has to be something. What goes on, right? Share with us what typically goes on in families that have been documented. You

Allison Schneider (21:36):

Know, I think the first thing I would highlight, and I don't know that this would come f - as a surprise, but there's just so much information to understand. I mean, just what we've been talking about today with different types of Medicare, different types of plan, ways that you can get cost assistance, that's a lot of information to digest. So really the first step is education. That Medicare and you handbook is a really good resource in addition to some of the state resources that are available to you. But that is, I think, one of the biggest struggles and hurdles because it's just very complicated to understand all of the different coverage parameters, and what options best for you. And I think that goes into why some beneficiaries choose not to make changes year to year, from the Medicare Advantage plan or, or other type of Medicare that they're enrolled in, because it can be kind of overwhelming to understand all of that.

Allison Schneider (22:33):

So that is maybe the number one. I think number two is the costs. Costs can be high in Medicare, which is why it's so important to every year, make sure that you're in the plan that provides you with the lowest cost sharing for the next year, and that if there is some way for you to get cost assistance, you're enrolled in that program.

Meryl Comer (22:58):

So the window is getting smaller <laugh> for us to make these decisions. Let's say we just started now, what should we focus on?

Allison Schneider (23:10):

I think the first thing to focus on if you're already in Medicare is looking at that annual notice of change. So understanding what's changing in my current plan between this year and next year, and that can help drive your decision with, you know, if not much is, not much is changing and you're happy with your coverage, then there may be less activity that's needed from you. But if there are changes, the next step would be comparing your options. So that would be using Medicare Plan Finder, that resource that I mentioned, to look at what other types of options are available in your area. And if you still have questions after that point, reaching out to assistance programs that are available within your state or from Medicare at a national level to get those questions answered before you make a decision.

Meryl Comer (24:00):

So should we trust AI's Copilot or - <laugh>

Allison Schneider (24:06):

That one I would say is high risk. I would not trust, not trust AI on this one, and there's a lot of resources available, to get the information that you need.

Meryl Comer (24:18):

Thank you so much. Our guest has been Allison Schneider, Director of Market Access Policy and Strategy at AbbVie Health. If this episode was useful, share it with a parent, sibling, friend, colleague who may be putting off this conversation or visit medicare.gov or call 1-800-MEDICARE. Coming up on part two of Brainstorm Scan of Medicare Open Enrollment, we examine Medicare drug coverage that has changed significantly in recent years. I'm Eryl Comer. Thank you for brainstorming with us.

Closing (24:59):

Support for Brainstorm by Us Against Alzheimer's comes from Lundbeck US. Lundbeck is dedicated to advancing brain health and transforming lives through focused innovation in neuroscience. Subscribe to Brainstorm through your favorite podcast platform and join us for new episodes on the first and third Tuesday of every month.