Every year from October 15 to December 7—Medicare’s Open Enrollment Period— people already enrolled in Medicare have the opportunity to change their coverage to a plan that better suits their needs or to keep the plan they already have.
Of course, that means individuals age 65 or older will soon be inundated with pamphlets, booklets, brochures, and other targeted marketing pieces on the various options available to them.
Unfortunately, this deluge of information often raises more questions than answers. Can you enroll in Medicare only during the Annual Enrollment Period? What are the various parts of Medicare? What’s the difference between Original Medicare and Medicare Advantage? Do you need supplemental coverage? In other words, how do you cut through all the Medicare clutter and choose the level of coverage that works best for you?
The following information from medicare.gov should help clear up some of the confusion surrounding Medicare enrollment for those who are or soon will be eligible:
When can I enroll in Medicare?
As mentioned, the annual Open Enrollment Period (OEP) from October 15 to December 7 is the timeframe during which anyone who has Medicare can choose to change their coverage or keep what they have for the upcoming year. (There is also an annual Medicare Advantage Open Enrollment Period from January 1 to March 31, which is only for those currently enrolled in a Medicare Advantage Plan.)
However, you don’t need to wait for the OEP to enroll in Medicare initially. People aging into Medicare have a seven-month window in which to enroll in a plan. This Initial Enrollment Period (IEP) spans the three months prior to the eligible individual’s 65th birthday, the month in which they turn 65, and the three months following their 65th birthday. Those who join during one of the three months before they turn 65 should be aware that their coverage will go into effect no sooner than their birthday month.
A, B, C, D—what do all those letters mean?
Trying to figure out the different Medicare parts can feel overwhelming, but it’s not as complicated as it seems. According to medicare.gov: Original Medicare is comprised of Part A and Part B. Part A, or hospital insurance, helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Part B is medical insurance and helps cover services from doctors and other healthcare providers, outpatient care, home health care, durable medical equipment, and various preventive services. Part A is free to most people age 65 and over who paid Medicare taxes while working, while Part B carries a premium.
Medicare Part D helps cover the cost of prescription drugs, including many recommended shots or vaccines. You can get Part D coverage by joining a Medicare drug plan in addition to Original Medicare or by joining a Medicare Advantage plan.
To help defray out-of-pocket expenses associated with Original Medicare, enrollees can also choose to purchase Medicare Supplemental Insurance, also known as Medigap, from a private insurer.
Medicare Advantage, or Part C, is a Medicare-approved plan from a private company that bundles Parts A, B, and (usually) D. Medicare Advantage plans often have lower out-of-pocket costs than Original Medicare and may offer additional benefits not included in Original Medicare.
What else do I need to consider?
There is much to think about before choosing an initial Medicare plan or changing your current coverage. Here are just some of those vital considerations:
How much will I have to pay out of pocket?
Consider that Original Medicare is essentially an 80/20 plan with a deductible and no out-of-pocket maximum, which means you can rack up major costs if, for example, you have to undergo multiple procedures in the same year. Also, if you want prescription drug coverage under Original Medicare, you’ll need to pay an additional monthly premium for a Medicare Prescription Drug plan. Medicare Advantage Plans, on the other hand, typically include drug coverage and offer low premiums, no deductibles, and out-of-pocket maximums.
n Under Original Medicare, you can go to any provider who accepts Medicare. However, if you choose a Medicare Advantage plan, you’ll need to use the providers that are part of the plan’s network. Be sure to verify that any doctors you currently see— or plan to see—are included in the network before committing to a plan.
While most Medicare Advantage plans include drug coverage, don’t assume a given plan will cover the specific drug or drugs that you’re currently taking. For example, if you’re currently managing your high cholesterol with a particular statin drug, you don’t want to find out too late that your new plan’s formulary doesn’t include that drug but, instead, covers a different one that may or may not be as effective for you. Check the plan’s formulary to make sure all your current medications
Will I be covered if I move to Florida?
The answer to this question is “possibly.” Again, under Original Medicare, you can go to any doctor who accepts Medicare, but Medicare Advantage plans may encompass only a certain geographic area. If you’ve had enough of Northwest Ohio winters and decide to head to Florida full time, make sure the Sunshine State is included in your plan’s service area first.
Are all Medicare plans the same in quality?
No, not all Medicare plans are created equal. The good news is, when you explore your Medicare coverage options at medicare.gov, you’ll discover that the agency helps to eliminate the guesswork in this regard by rating the quality of different plans using a one- to five-star rating system.
Remember, no one Medicare plan is appropriate for everyone. The best plan for you is the one that meets all your unique coverage needs—not necessarily the one that’s best for your friends or family members. For more comprehensive information on Medicare coverage and how to choose the right plan for you, visit medicare.gov. ✲
