​FIFTY PLUS - September 2025

HOMEWORK …. GETTING READY FOR THE FALL ENROLLMENT SEASON

September is a great time to prepare for “AEP / OEP"  - Annual / Open Enrollment Period. This is when you may make changes to your Medicare and ACA Marketplace plans.

AEP – Medicare: Window Shopping October 1. Make changes from October 15 to December 7, 2025.

For Medicare folks; You’ll receive an “Annual Notice of Change” ( ANOC) in September. This details changes to the exact Medicare Advantage or Part D – Rx you currently have. OEP – ACA: Make changes from November 1 to January 15, 2026. And YOU have some HOMEWORK to be ready.

HOMEWORK if you have a Medicare Supplement
  •  Review your current premium.
  •  What was the increase this last year?
  •  Compared to prior years?
  •  Are you looking to make a change?

HOMEWORK if you have a Part D – Rx plan.
  • Review your current plan and what it is changing to next year.
  • Are all your prescriptions covered; i.e. on the plan formulary?
  • If brand name RX, what’s the Copay and Rate Tier?
  • Is your pharmacy “preferred“ for that plan?

HOMEWORK if you have a Medicare Advantage Plan

For the Medical
  • What is the copay for Primary Doctor and Specialists?
  • Daily Rate for Hospitalization and number of days you have to pay ?
  • What’s the Maximum Out Of Pocket ( MOOP ) for medical expenses ?
  • For the Prescription part - same as Plan D RX above.

For Networks of contracted Doctors and Providers
  • Is your Primary Care Physician and Specialists in the network?
  • Hospital System?
  • Is the plan an HMO, POS or PPO?

For the Extra’s
  • What is the Dental Benefit?
  • Vision & Hearing?
  • Is membership to your gym or fitness club covered?
  • Is there a “Giveback“ on your Part B premium?

Type of Medicare Eligibility
  • Do you have both Medicare and Medicaid?
  • Do you qualify for “Low Income Subsidy”
  • Have you a covered diagnosis like diabetes, heart disease or lung issues?

HOMEWORK if you have an ACA / Marketplace Plan
  • Review your current plan, net premium, subsidy and the income estimate you used
  • Is your family changing next year ? Dependent turning 26? spouse eligible for Medicare ?
  • On your 2024 1040, what was “ line 11 “ ? Add your Social security if already or will be taking.
  • Will your income for 2026 be greater than 400% of federal poverty level - $63,000 single, $85,000 family of 2, $128,000 family of 4?
  • Do you have an IRA or 401K? This can help control Line 11. Remember: Your health insurance is ALL about YOU! Your Needs, Your values and Your budget. At Trout Insurance, we listen carefully and then work with you to Discover Your Options.

​Dave Trout
Trout Insurance

Full Service, Local, Independent
29 N Main St. Weaverville, NC
828-279-4681
[email protected]