Q & A: October 15 – December 7 Is Medicare Open Enrollment

Senior couple looking at the computer

Last year, Nancy and Sam didn't pay much attention during the Medicare Open Enrollment period — only to find out later that their doctors and pharmacy were no longer included in their Medicare Advantage plan. It was a costly mistake! This year, they're doing their homework.

If you or a loved one has Medicare, here are questions to ask:

Q: What is Medicare Open Enrollment?

Each year between October 15 and December 7, people who are on Medicare have a chance to change their Medicare health plans and prescription drug coverage.

First, a quick overview. Medicare has four parts:

  • Medicare Part A: Hospital Insurance covers inpatient hospital care, skilled nursing care, hospice care, and some home healthcare.
  • Medicare Part B: Medical Insurance covers certain doctors' services, outpatient care, medical supplies and preventive services.
  • Medicare Part C plans, also called Medicare Advantage plans, are health plans offered by private insurance companies that provide Part A and Part B benefits; many also include Part D prescription drug coverage and other benefits.
  • Medicare Part D is prescription drug coverage.

During Open Enrollment, a person on Medicare may …

  • Switch to a Medicare Advantage plan from Original Medicare (Parts A and B), or vice versa.
  • Sign up for or switch their Part D prescription plan.
  • Switch from one Medicare Advantage plan to another.

Q: How can seniors on Medicare make the best choice during Open Enrollment?

Many people with Medicare stick with the same coverage year after year because it's easiest to coast along with the status quo. But when the new year rolls around, they may be in for an unpleasant surprise when they see the new cost of their monthly premium, open their first medical bill of the year, or go to pay for a prescription! Insurance companies that offer prescription (Part D) and/or Medicare Advantage (Part C) plans may make big changes from year to year. Your doctor may no longer be "in-network" (a network is a list of doctors covered by your policy). Your plan may cover less of the cost of the drugs you take — or might drop certain drugs entirely. Or perhaps your favorite pharmacy is no longer in-network. Even if things have stayed the same, you might be overlooking a better deal from someone else. So it's important to compare all the plans that are offered in your area.

Q: That sounds complicated! Who can help?

Your mailbox may be stuffed with solicitations from other companies, but be sure to examine materials from your current plan, called "evidence of coverage" and "annual notice of change." These are notices of the costs for 2019, as well as coverage details that may have changed since 2018. If you don't receive this information, ask your insurer to provide it. Read these materials carefully.

If you're still satisfied with your current policy, you don't need to do anything. But it pays to compare! You can get help from:

  • The Medicare Plan Finder, which will give you a personalized list of plans in your area, allowing you to compare them with your current plan.
  • Your State Health Insurance Assistance Program (SHIP). You can get free, unbiased assistance from a trained counselor as you make the decision. (Find your state SHIP here; it may be called by a slightly different name, such as SHIBA.)

Please note: Some insurance companies and brokers have put up websites that might at first glance seem like official Medicare sites, but aren't. Medicare.gov and the Centers for Medicare & Medicaid Services are the official U.S. government sites for Medicare.

Q: Can I select a Medigap policy now, too?

Sometimes people who've been on a Medicare Advantage plan decide, for various reasons, to go back to Original Medicare (Parts A and B). They also might decide to purchase a supplemental insurance policy from a private insurance company — called "Medigap" policies because they're designed to cover the "gaps" in Medicare coverage, such as deductibles, copayments and medical charges beyond Medicare's limits.

But there's a catch. People who are about to turn 65 should know that in most states, after the first six months that a person starts receiving Medicare, insurance companies aren't required to allow them to sign up for a Medigap policy. A person can be turned down for a Medigap policy if they have a preexisting condition such as diabetes, rheumatoid arthritis or heart disease.

It is a complicated situation. To learn more, check out this article from Kaiser Health News

Q: If I'm about to turn 65, do I need to wait for Open Enrollment to sign up for Medicare?

No. The initial Medicare enrollment period begins three months before your 65th birthday — even if you do not intend to file for Social Security benefits yet. You will have a lot of decisions to make, so start planning early. Visit the Medicare.gov website to learn more.

Does Medicare cover the immunizations you need? Read all about it in "Vaccines for Seniors Covered by Medicare" in this issue of the Caring Right at Home online newsletter.

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