Changes are coming to Medicare that could be significant to some beneficiaries when the annual open enrollment period occurs Oct. 15-Dec. 7.

Specifics of health plan changes aren’t yet available, but new features to drug plans will be coming Jan. 1 as part of the federal Inflation Reduction Act, said Karri Morris, Medicare manager with the North Dakota Insurance Department.

“Starting in 2025, the annual out of pocket costs are now going to be capped at $2,000 for people with Medicare Part D, so that’s going to eliminate the coverage gap, or what was also known as the doughnut hole,” she said. “The expectation is that’s going to help people with Medicare Part D who take those more expensive drugs. They’re not going to have that higher out of pocket.

“Also, for the first time, this law is going to require that all Medicare Part D plans, including both stand-alone prescription plans and the Medicare Advantage plans with prescription coverage, have to offer enrollees the option to pay out of pocket prescription drug costs in the form of capped monthly installments, instead of all at once at the pharmacy,” she said.

How the law will be administered and how those plan changes will look isn’t certain, but it will be a consideration for impacted beneficiaries looking to find their best plans, Morris said.

It is important that beneficiaries review their plan options every year because plan features and costs do change, she added. Some plans may be withdrawn from the offerings. If beneficiaries miss those notices that their plans are ending and assume they can continue with their plans, they could be caught without Medicare coverage until the next open enrollment period.

“We always like to tell people, too, that once open enrollment starts, it’s just a good reminder to get those reviews done sooner than later,” she said. “Once you wait toward the end of open enrollment, sometimes it can be a little bit more challenging with actually enrolling into a plan. A lot of plans are backed up. They have long wait times.”

Counselors with the N.D. Insurance Department’s State Health Insurance Assistance Program (SHIP) will begin making appointments Oct. 1 to provide free assistance in reviewing plans to Medicare beneficiaries after Oct. 15. Again, scheduling those appointments early is advisable. Most appointments will be available via phone.

SHIP counselors also will be available at different locations in the state, and once those dates and locations are known, the information will be made available to the public.

Last year, SHIP worked with 4,678 individuals and provided more than $2.44 million in relief. Numbers have been steady in recent years but have been higher in the past.

Morris said SHIP has seen a large drop in volunteers in its counseling service, which has been a challenge for the program. However, SHIP now is working with five partner agencies throughout the state to reach more residents.

Individuals interested in volunteering can contact the Insurance Department and fill out an application.

Morris said people can use Medicare’s online Plan Finder to do their own research into plans after Oct. 15. If they still have questions, they can reach out to SHIP, she said.

According to research reported by AARP, most couples enrolled in Medicare Advantage plans stick together when choosing health coverage rather than choosing plans based on their individual health needs. It’s not a recommended strategy.

“It’s important that each individual do their own plan comparisons, because, especially with Part D and even the Medicare Advantage plans, it’s all dependent on what medications they’re taking and what formulary those meds are on. One plan that may be more cost effective for one individual may be completely different for that other individual,” Morris said.

“We tell people, you just don’t need to look at your premiums. You want to look at the overall cost of the different plan options, and what medications you’re taking,” she said. “With the new Inflation Reduction Act law, along with some new plans that North Dakota is offering for lower income individuals, those plans may look a little bit different this year than they historically have.”