Navigating the Medicare maze is confusing enough, but the added pressure of the looming open enrollment deadline can be overwhelming. Here are 10 things seniors should know.
1. Open enrollment runs from October 15 to Dec 7, 2015
This window is the time that seniors can sign up for Medicare Advantage (Part C) or Medicare Prescription Drug Coverage (Part D) or they can make changes to an existing plan, move to a new one, change drug coverage benefits or dis-enroll.
2. There are two ways to get Original Medicare (Part A and Part B)
Choose Original Medicare on its own, with the option to add Medicare Part D prescription drug coverage. If you collect benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically get Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). There is a premium for Part B. If you don't need to keep Part B (for example, if you are covered through active employment or that of your spouse), you must follow the directions when you get your Medicare card indicating you don't want it. Otherwise, you will be charged.
Or choose a Medicare Advantage (Medicare Part C) plan that bundles Original Medicare with extra benefits and may include prescription drug coverage in one plan. Medicare Advantage Plan is like an HMO or PPO. You may have to go to doctors within their service network or pay higher co-pays for going out of network.
3. Your share of the Medicare costs may be larger than you expect
Medicare, the traditional benefit provided by the government, doesn't cover all medical expenses. For example, approximately of 20% of physician fees are paid by the Medicare beneficiary. Seniors often find themselves paying out-of-pocket for many of their healthcare expenses.
4. Medicare Advantage Plans pick up where Medicare leaves off
A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. This insurance provides your Part A, Part B and oftentimes, Part D coverage. You use a Medicare Advantage card for health care.
Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.
5. Timing matters
Timing matters when you're joining Medicare. When you turn 65 or otherwise become eligible for Original Medicare (Parts A and B), enrollment windows open. But some of these windows will close quickly. If you wait until later to sign up, you may have fewer choices, and you may pay more. During Open Enrollment Period, you can:
- Change from Original Medicare to a Medicare Advantage Plan.
- Change from a Medicare Advantage Plan back to Original Medicare.
- Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
- Switch from a Medicare Advantage Plan that doesn't offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
- Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn't offer drug coverage.
- Join a Medicare Prescription Drug Plan.
- Switch from one Medicare Prescription Drug Plan to another.
- Drop your Medicare prescription drug coverage completely.
6. Know what you're paying
When you're deciding whether or not to add, change or drop plans, pay attention to what you're paying. Look at your total out-of-pocket healthcare expenses from last year. It's not just the premium, but check to see what may have changed with the deductible, co-pays, prescription drug costs.
7. Doing nothing is an option
If you don't make any changes during Medicare Open Enrollment, your existing plans will rollover at the end of the enrollment period with no changes and your existing coverage will remain in effect.
8. If you miss the deadline, there may still be hope
If you missed the deadline, you may have to wait until next year before you make changes, or you will pay penalties and higher premiums.
However, there is a second enrollment period from January 1 to February 14, 2016. During this time, you can:
- If you're in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare.
- If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
9. Sometimes it's not so easy to "just switch back"
An insurance agent might say that "if you don't like the Medicare Advantage plan, you can just switch back." But it's not that easy. You can get stuck in a plan. You can only drop Medicare Advantage during certain time periods. In recent years, a new "disenrollment period" for Medicare Advantage plans is offered. From January 1 through February 14, 2016 a senior can disenroll if they are unhappy with the Medicare Advantage Plan they purchased. They can go back to regular Medicare coverage and, if they wish, pick up a prescription drug plan. (But beware: Medigap is different. Once you give up a Medigap plan, you might not be able to get it back.)
10. Get help if you need it
Don't go it alone. If you don't understand something, ask for help. For more detailed information about signing up for Medicare Advantage Plans (Part C) or Medicare prescription drug coverage (Part D), including instructions on how to join, visit www.medicare.gov. You can also call 1-800-MEDICARE (1-800-633-4227).