STARTING THIS MONTH, people age 65 and older will find themselves inundated with commercials, pamphlets, booklets, brochures, and other targeted marketing pieces informing them about the various Medicare options available to them. This informational campaign kicks off this time every year because Medicare’s annual Open Enrollment Period begins on October 15 and continues through December 7. During this 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.
Though its purpose is to educate, this deluge of information often raises more questions than answers. So, how can you cut through all the clutter and choose the level of coverage that works best for you? The following information gleaned from medicare. gov should help clear up the confusion surrounding Medicare enrollment for those who are, or soon will be, eligible:
What is the purpose of the annual Open Enrollment Period?
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.
What does the Medicare “alphabet soup” mean?
Trying to figure out the different Medicare parts—A, B, C, D, etc.—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, nursing home care, hospice care, and home health care. Part B covers medically necessary services that are needed to diagnose or treat your medical condition, as well as preventive services. Examples include clinical research, ambulance services, durable medical equipment, mental health services (inpatient, outpatient, and partial hospitalization), and limited outpatient prescription drugs.
Medicare Part D covers the cost of most outpatient prescription drugs, including many recommended shots or vaccines. Private companies offer Part D coverage either as a standalone plan, for individuals enrolled in Original Medicare, or as part of the combination of benefits included in a Medicare Advantage plan.
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.
To help defray out-of-pocket expenses associated with Original Medicare, enrollees can choose to purchase Medicare Supplemental Insurance, also known as Medigap, from a private insurer.
What else should you 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 has 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, have a yearly limit on out-of-pocket costs, so once that limit is reached, you’ll pay nothing for covered services for the rest of the year.
Can I still see the doctor( s) of my choice?
Under Original Medicare, you can go to any provider who accepts the coverage. However, if you choose a Medicare Advantage plan, you’ll need to use providers that are part of the plan’s network. Be sure to verify that any doctors you currently see—or intend to see—are included in the network before committing to a plan.
Are all my prescription drugs covered?
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. Check the new plan’s formulary to make sure.
Will I be covered if I move?
Again, under Original Medicare,
you can go to any doctor who accepts Medicare, but Medicare Advantage plans may encompass only a certain geographic area. Make sure your destination is included in the plan’s service area.
Remember, no one Medicare plan is appropriate for everyone. The best plan for you is the one that meets all your unique coverage needs at the most manageable price. For more comprehensive information on Medicare coverage and how to choose the right plan for you, visit medicare.gov. ✲
