If you’re like most people, the information you receive about Medicare through the mail, from insurance agents, or talking with friends, family, and co-workers is confusing! And the abundance of conflicting information can leave you anxious, worrying that you’ll do the wrong thing like miss a key enrollment period or incur hefty penalties.
Do any of these sound familiar to you?
- Joe says I should wait until Open Enrollment in the fall to enroll.
- A brochure I received in the mail says I HAVE to enroll in Medicare at age 65.
- My neighbor says if I have health insurance through my employer, I don’t need to enroll in Medicare.
- My cousin says I don’t need to enroll in Medicare Part D if I’m not on any medications now, and that I can enroll in a Part D plan at any time.
- My best friend says to just enroll in a cheap plan now since I’m healthy, and that I can always change to a better plan during Open Enrollment.
One area of confusion for many people is the various enrollment periods for Medicare. Very few people are clear on which enrollment period is for what situation, and what the implications are if you miss the relevant enrollment period. Because Medicare Open Enrollment is approaching, we decided this would be a good time to provide you with the information you need regarding this enrollment period.
First, a brief description of the Medicare parts. Part A is hospital insurance, Part B is medical insurance, Part C (also called Medicare Advantage) is a private health care plan that contracts with Medicare to provide Part A and Part B benefits, and Part D is for prescription drug coverage.
What is Open Enrollment?
Medicare Open Enrollment occurs every year from October 15th through December 7th. The term “Open Enrollment” seems to imply that anyone can enroll in Medicare at this time. In reality, Open Enrollment is for making CHANGES to your existing Medicare coverage - primarily your Medicare Advantage Plan (or Medicare Part C), or your Medicare Part D prescription drug plan.
Here is what you can do:
- Switch from one Medicare Advantage plan to another Medicare Advantage plan
- Enroll in a Medicare Part D prescription drug plan
- Switch from one Medicare Part D prescription drug plan to another
- Switch from an Original Medicare supplement plan to a Medicare Advantage plan
When you do make a change in your coverage, the new plan will be effective January 1st.
You can NOT change from a Medicare Advantage plan to an Original Medicare supplement plan during Open Enrollment. You can only do this from January 1st through February 14th every year. And if you’ve been on your Medicare Advantage plan for 12 months or longer, you MAY NOT QUALIFY for an Original Medicare supplement plan if you have health issues. This is one reason the decisions you make when you first become Medicare eligible are so important - you may not be able to make changes in the future.
Why would you want to make changes to your coverage?
In most cases, people change their plans due to an increase in the premium of their current plan, or an increase in the copay amounts. But another reason you might want to change from one Advantage plan to another is that the network of providers may have changed; for example, if the doctors you are currently seeing decide to drop out of your plan’s network. This also applies to Medicare Part D plans - the copays may go up for your medications, or perhaps you are on new medications which are very expensive on your current plan, or the pharmacy you like is no longer in the plan’s network. To make a change in your Medicare coverage, you simply enroll in the Medicare Advantage plan or Part D prescription plan you want, and you will automatically be dropped from your current plan.
So who should you listen to?
Retirement Advisors has retained the services of an expert who specializes in this area of planning, and who has the experience and knowledge to provide you with the advice, guidance, and recommendations that will get you through the confusing world of Medicare. We offer a free review as a value-added benefit to clients and those who are considering becoming a client.
If you’d like to learn more about Medicare and ask any questions you may have, request a complimentary Medicare review session today.
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