Medicare Open Enrollment 101: All You Need to Know

Posted by Krista Johnson on Nov 27, 2018 10:50:00 AM

Medicare Open Enrollment, the annual period in which you can change your Medicare coverage, is in full swing, and we’ve seen a recent influx in interest revolving around the topic. So do you know what to keep an eye out for during Open Enrollment?

First, let’s run through some terms and nail down the details of the different plans:

Original Medicare- Includes Part A (hospital insurance) and Part B (medical insurance), and you can join a separate Part D (prescription coverage) plan. With Medicare, you are able to visit any doctor that accepts Medicare, and typically will not need a referral to see a specialist. You will pay a monthly premium for Part B, and after you meet your deductible you will usually pay 20% of the Medicare-approved amount for Part B covered services. There is also no yearly limit on what you pay out-of-pocket, and you are able to purchase supplemental coverage.

Medicare Advantage Plan (MAP)- Also known as Part C, Medicare Advantage includes Part A, Part B, and most plans cover Part D. Some plans also include vision and dental benefits, which could possibly be a huge consideration when choosing your plan! Medicare Advantage Plans include:

  • Health Maintenance Organizations
  • Preferred Provider Organization
  • Private fee-for-service plan
  • Special needs plans
  • Medicare medical savings account plan

This plan limits you to only seeing doctors who are in network, and will sometimes need a referral to see a specialist. Unlike Original Medicare, you will pay a premium for the plan itself as well as a premium for Part B. Plans have a yearly limit on out-of-pocket expenses for Part A and Part B services. Once that limit is reached, you will pay nothing for the remainder of the year for Part A and Part B services. You are not able to purchase supplemental coverage.

Part A- Generally speaking, Part A will act as Hospital Insurance and help cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

Part B- This will act as Medical Insurance and help cover doctor and health care services, outpatient care, home health care, durable medical equipment, and preventative services.

Part D- Helps cover prescription drugs. These plans are run by private insurance companies that follow rules set by Medicare.

Medigap (Medicare Supplement Insurance)- An extra health insurance bought from a private company to pay for costs Medicare does not cover, such as copayments, deductibles, and travel health care.  

Deductible- The amount you are required to pay for health care services or prescriptions before Original Medicare or supplemental insurance steps in to pay.

Premium- Recurring payments to Medicare, insurance companies, or health care plans for health services or prescription drug coverage.

Now that we have covered the terminology around Medicare and Open Enrollment, let’s dive into the details of this yearly time frame. You can also find more information about plans and rules, from Medicare’s guide and their interactive Medicare Plan Finder!

Open Enrollment, Here’s What You Can Do

Between the dates of October 15-December 7, you can:

  • Switch from Original Medicare to Medicare Advantage
  • Switch from a Medicare Advantage Plan to Original Medicare
  • Change from one Medicare Advantage Plan to another. Remember, there are many plans and you should shop around to find what is best for your health needs! While you may have been pleased with your current plan, costs vary each year and different benefits and prescriptions are added and dropped. It’s important to have a good idea of what health services and prescriptions you will need in the coming year to find the most beneficial plan.
  • Sign up for a Part D plan
  • Cancel a Part D plan
  • Switch from one Part D plan to another Part D plan

Here’s What You Can’t Do

  • You are not able to enroll in Part A and or Part B for the first General Enrollment Period for either plan is from January 1-March 31.

Enrollment Info

Keep in mind that Initial Enrollment Period (IEP) and General Enrollment Period (GEP) are completely separate. Your IEP is during a 7-month time-frame: 3 months prior to your 65th birthday month, the month of your 65th birthday, and 3 months afterwards. Haven’t enrolled or missed your dates? Sometimes it can be beneficial to use your spouse’s insurance plan to cover expenses until you are able to enroll during the next available period.

A common misconception is that everyone is automatically enrolled in Medicare, however, failure to enroll if you need to can cause penalties for late enrollment! You will be automatically enrolled in Medicare Parts A and B if you are currently collecting any form of Social Security retirement or disability benefits.

Don’t Forget About Disenrollment

There’s no doubt you have read everything about open enrollment by now, but did you remember to think about disenrollment? That’s right, this month-long period between January 1-February 14 is designed if you are dissatisfied with your Medicare Advantage Plan allowing you to switch to Original Medicare with or without Part D. Just by knowing about disenrollment could save you a hefty chunk of money if you were to continue with the same plan that was inefficient for the rest of the year until next enrollment period.

 

If you’d like to get individualized help on specific Medicare or Open Enrollment questions, please contact Krista Johnson. We look forward to seeing how we can be of benefit to you!