Submitted by Pam Deaton, HealthMarkets Insurance
There are many reasons why you might want to change your Medicare coverage. And it’s important to know that this can only be done during the Open Enrollment Period, which occurs between October 15 and December 7. You may see different names for the Medicare Open Enrollment Period. It may also be called the Annual Enrollment Period, Annual Election Period, or the Medicare Fall Open Enrollment. But these all refer to the same October 15 to December 7 Open Enrollment dates.
The Open Enrollment time period is when individuals can change their Medicare Advantage and/or Medicare Part D plans. It’s also the time that you can switch from Original Medicare to Medicare Advantage, (or vice versa). Some of the reasons why you would want to join a Medicare Advantage or Medicare Part D drug plan during Open Enrollment include:
- Medicare Advantage includes Original Medicare plus more. MA plans must include Original Medicare Part A and Part B benefits. This makes MA plans a convenient way to get your Part A hospital insurance, Part B medical insurance, and extra health benefits.
- Original Medicare doesn’t cover every medical service. Medical services—such as routine care for dental, vision, and hearing—are not covered under Original Medicare. But you can access these health benefits by enrolling in Medicare Advantage.
- Medicare Advantage plans limit your out-of-pocket spending. Unlike Original Medicare, which doesn’t have a limit on how much your out-of-pocket costs such as coinsurance and copays can add up to, Medicare Advantage plans have a yearly out-of-pocket limit for covered Part A and Part B medical expenses. These plans pay for all your covered expenses after you’ve reached the plan’s yearly limit.
- You do not get prescription drug coverage automatically when you enroll in Medicare. To get coverage for your medications, you can join a standalone Medicare Part D Prescription Drug Plan. Or, you can switch from Original Medicare to a Medicare Advantage Prescription Drug Plan.
Why You Should Review Your Medicare Coverage During the Open Enrollment Period
No matter what kind of Medicare plan you have, it’s important that you review your Medicare options during the open enrollment period. Here are some reasons you may want to re-evaluate your Medicare choices:
- To make sure your coverage meets your current healthcare needs: If your health has changed and you’re not sure if your plan adequately meets your needs, you should explore and compare other options.
- To make sure your current medications are covered: Drugs on a plan’s formulary can change every year and the price you pay for your medicines can be different from plan to plan.
- To see if you can better manage your out-of-pocket medical expenses: There are options that might save you money, such as a zero-premium Medicare Advantage plan or a Medicare Supplemental plan.
- To make sure you have access to your preferred healthcare providers: Make sure your plan includes your favorite doctors, specialists, healthcare facilities, and pharmacies.
Medicare Open Enrollment vs. Medicare General Enrollment Period: What’s the Difference?
Unlike Medicare Open Enrollment Period, the Medicare General Enrollment Period takes place annually from January 1 to March 31. This is the time of year when you can join Original Medicare Parts A and B for the first time if you didn’t sign up for Medicare benefits when you were first eligible. Open enrollment is when you can switch and change your existing Medicare coverage, while General Enrollment is when you can sign up for the first time.
Getting Medicare for the First Time
The best time to sign up for Medicare benefits to avoid paying higher premiums and late enrollment penalties is during your Initial Enrollment Period which is the seven-month period surrounding your 65th birthday month. But if you or your spouse are still working or you have group health insurance through your current job, you can delay your enrollment. If this applies to you, you will get a Special Enrollment Period to sign up for Medicare when you or your spouse stops working or your employer-based health coverage ends.
If you choose to delay enrollment in Medicare Part A, Part B, or both during your Initial Enrollment Period, you get another chance to enroll during the Medicare General Enrollment Period from January 1 to March 31. When you sign up for Medicare during this time frame, you may have to pay late-enrollment penalties and possibly increase your premium. It’s important to remember that the General Enrollment Period (January 1 – March 31) only allows you to enroll in Medicare Parts A and B. You can’t switch or change plans.
Medicare shouldn’t be so complicated and difficult to understand—but it is. Who wants to spend hours and hours figuring this out, when you can have a 30-minute appointment and let an experienced HeathMarket Agent do it for you! A HealthMarket agent does not push any particular policy and their services are free. They meet with you, determine your needs, explain in plain language what your options are, and take care of all the paperwork for you. Call Pam Deaton of HealthMarkets to schedule a free consultation at 309-287-3518.
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