Influenza (flu) viruses are detected year-round in the U.S. but are most common in the fall and winter. This year, the CDC recommends most people get the flu vaccine in September of October. There are many benefits to the flu shot, as the flu shot:

Can prevent you from getting sick with the flu
Has been shown to reduce severity of illness in people who get vaccinated but still get sick
Is an important preventive tool for people with certain chronic health conditions.
Helps protect pregnant people during and after pregnancy
Can be lifesaving in children
And, may also protect people around you.
Medicare covers one flu shot every flu season. Speak to your doctor if you have any questions about the flu vaccine.

Dear Marci,

I’ve had Original Medicare for a few years, but I’m planning to join a Medicare Advantage Plan during Fall Open Enrollment this year. How should I choose a Medicare Advantage Plan when there are so many options?

-Rhonda (Spring, TX)

Dear Rhonda,

It’s important to choose a Medicare Advantage Plan that fits your unique needs. Even if your friend or family member loves their Medicare Advantage Plan, it might not work well for you. There are numerous questions you can ask about a plan to determine if it would be a good fit for you, and you can find those below.

You may find it helpful to use Medicare’s Plan Finder tool to learn about the plans available to you. You can even call 1-800-MEDICARE (1-800-633-4227) to request their help with comparing these plans over the phone. Before enrolling in a plan, though, it is a good idea to call the plan directly to confirm what you have learned about it.

You can ask yourself the following questions before choosing a Medicare Advantage Plan:

How much are the premium, deductible, and coinsurance/copay amounts?
What is the annual maximum out-of-pocket cost for the plan? This amount may be high but can help protect you if you have expensive health care costs.
What service area does the plan cover?
Are my doctors and hospitals in the plan’s network?
What are the rules I have to follow to access health care services and my drugs?
Does the plan cover additional health care benefits that are not covered by Original Medicare?
How will this plan affect any additional coverage I may have?
What is the plan’s star rating?
Medicare Advantage Plans usually include prescription drug coverage. You should also consider these questions when choosing a Medicare Advantage Plan to make sure that the prescription drug coverage that the plan offers meets your needs:
Does the plan cover all the medications I take?
Does the plan have restrictions on my drugs (i.e. prior authorization, step therapy, or quantity limits?)
Prior authorization means that you must get approval from your Part D plan before the plan will pay for the drug.
Step therapy means that your plan requires you to try a cheaper version of your drug before it will cover the more expensive one.
Quantity limits restrict the quantity of a drug you can get per prescription fill, such as 30 pills of Drug X per month.
How much will I pay for monthly premiums and the annual deductible?
How much will I pay at the pharmacy (copay/coinsurance) for each drug I take?
Is my pharmacy in the plan’s preferred network? You pay the least if you used preferred network pharmacies.
Can I fill my prescriptions by mail order?
If I have retiree coverage, will the Medicare drug plan work with this coverage?
What is the plan’s star rating?
Remember that Fall Open Enrollment runs from October 15 through December 7 each year. During this time, you can make changes to your health insurance coverage, including adding, dropping, or changing your Medicare coverage. When you are ready to enroll in a new Medicare Advantage Plan, you can call 1-800-MEDICARE (800-633-4227) to make the change.

Finally, note that enrollment rules for Medigaps are different. If you later wish to switch from Medicare Advantage to Original Medicare with a Medigap, you may not have the right to purchase a Medigap. There are only a few specific protected times to purchase a Medigap under federal rules, but your state may offer additional rights. To determine whether you could make the switch back to Original Medicare with a Medigap, I would encourage you to reach out to your State Health Insurance Assistance Program (SHIP), as they will be familiar with the Medigap rules in your state.

-Marci

Dear Marci,

I just enrolled in Medicare a few months ago, and now I am hearing about Fall Open Enrollment coming up. What is Fall Open Enrollment, and what should do I do during this time?

-Patty (Providence Forge, VA)

Dear Patty,

What an important question! Fall Open Enrollment begins October 15 and ends December 7 each year. (You also might hear it be called Medicare’s Open Enrollment Period or Annual Election Period.) During this time, you can make changes to your health insurance coverage, including adding, dropping, or changing your Medicare Advantage and Part D coverage for next year. Even if you are happy with your current health and drug coverage, Fall Open Enrollment is the time to review what you have, compare it with other options, and make sure that your current coverage will meet your needs for the coming year.

You can make as many changes as you need to your Medicare coverage during Fall Open Enrollment. The changes you can make include:

Joining a new Medicare Advantage Plan
Joining a new Part D prescription drug plan
Switching from Original Medicare to a Medicare Advantage Plan
Switching from a Medicare Advantage Plan to Original Medicare (with or without a Part D plan)
You should consider:
Your access to health care providers you want to see
Your access to preferred pharmacies
Your access to benefits and services you need
The total costs for insurance premiums, deductibles, and cost-sharing amounts
If you have Original Medicare, visit www.medicare.gov or read the 2023 Medicare & You handbook to learn about Medicare’s benefits for the upcoming year. You should review any increases to Original Medicare premiums, deductibles, and coinsurance charges.

If you have a Medicare Advantage Plan or a stand-alone Part D plan, read your plan’s Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC). If you do not receive these notices by the end of September, contact your plan to request them. Review these notices for any changes in:
The plan’s costs
The plan’s benefits and coverage rules
The plan’s formulary (list of drugs your plan covers)
Additionally, make sure that your drugs will still be covered next year and that your providers and pharmacies are still in the plan’s network. If you are unhappy with any of your plan’s changes, you can enroll in a new plan. If you want assistance reviewing your options, contact your State Health Insurance Assistance Program (SHIP) for unbiased counseling.

Even if you are happy with your current Medicare coverage, consider other Medicare health and drug plan options in your area. For example, even if you do not plan to change your Medicare Advantage or Part D plan, you should check to see if there is another plan in your area that will offer you better health and/or drug coverage at a more affordable price. Research shows that people with Medicare prescription drug coverage could lower their costs by shopping among plans each year; there could be another Part D plan in your area that covers the drugs you take with fewer restrictions and/or lower prices. You can use Medicare’s Plan Finder tool to compare your options and call your SHIP for assistance.

Best of luck to you this Fall Open Enrollment Period! Following the advice above, you can make sure your health coverage will meet your needs in 2023.

-Marci

Sleep is essential. According to the Office of Disease Prevention and Health Promotion (OASH), getting enough sleep can help us get sick less often, stay at a healthy weight, reduce stress, improve mood, and lower our risk for serious health problems. It’s not uncommon to struggle with getting good sleep, though. Luckily, Mayo Clinic has some habits we can adopt to encourage better sleep:

Stick to a sleep schedule. Consistency is key!
Pay attention to what you eat and drink. (Don’t go to bed hungry or stuffed, and note that nicotine, caffeine, and alcohol can interfere with sleep.)
Create a restful sleep environment.
Limit daytime naps.
Include physical activity in your daily routine.
Manage worries.
Know when to contact your health care provider. Nearly everyone has an occasional restless night, but if this is a common occurrence, contact your health care provider to identify any underlying causes.

Dear Marci,

I currently have Original Medicare and am considering switching to a Medicare Advantage (MA) Plan. I am worried I will regret it and want to switch back, though… Is it easy to switch between the two? How would I switch between Original Medicare and Medicare Advantage again in the future?

-Mathilda (Wasilla, AK)

Dear Mathilda,

Typically, you can only switch between Original Medicare and Medicare Advantage during specific times each year.

First, is the Fall Open Enrollment Period (also known as Medicare’s Open Enrollment Period), which occurs each year from October 15 through December 7. During this period, you can change your choice of health coverage and add, drop, or change Medicare drug coverage. You can make as many changes as you need during this period, and your last coverage choice will take effect January 1. To avoid enrollment problems, it is usually best to make as few changes as possible.

If you are planning to use Fall Open Enrollment to switch to a Medicare Advantage Plan, it is helpful to know that you will have an additional enrollment period early in the new year, called the Medicare Advantage Open Enrollment Period (MA OEP). During this time, you can switch from your Medicare Advantage Plan to another Medicare Advantage Plan, or to Original Medicare with or without a stand-alone prescription drug plan (Part D). The MA OEP occurs each year from January 1 through March 31 and changes take effect the first of the month following the month you make the change. For example, if you switch from a Medicare Advantage Plan to Original Medicare in February, your new coverage begins March 1. Unlike Fall Open Enrollment, you can only make a single change during the MA OEP. Remember, you can only use this enrollment period if you have a Medicare Advantage Plan.

Additionally, under certain circumstances you may be eligible for a Special Enrollment Period (SEP). SEPs allow you to change your health and/or drug coverage outside normal enrollment periods. For example, if your Medicare Advantage Plan would leave your area or you would move out of your plan’s service area, you would receive an SEP to switch to another MA Plan or to Original Medicare. There are several circumstances that may trigger an SEP.

To make changes during any of the above enrollment periods, you can call 1-800-MEDICARE (633-4227).

Finally, note that the enrollment rules for Medigaps are different, and changing to a Medicare Advantage Plan may change how other insurance you might have works with your Medicare. If you want to switch from Original Medicare with a Medigap to a Medicare Advantage Plan, learn about and carefully consider when and if you will have the right to re-join your Medigap or buy a new one if you want to switch back to Original Medicare at a later date. There are only a few specific protected times to purchase a Medigap under federal rules, but your state may offer additional rights. To determine whether you can make the switch, I would encourage you to reach out to your State Health Insurance Assistance Program (SHIP), as they will be familiar with the Medigap rules in your state.

Best of luck!

-Marci