It’s Medicare open enrollment period starting Oct. 15 and through Dec. 7. Your chance to change coverage (Medicare plans) if you want.
Medicare Part C plans, known as Medicare Advantage plans are private health insurance plans, mainly HMOs and PPOs, for people enrolled in Medicare. If you enroll in a Medicare Advantage plan, you still have Medicare, but you get all of your Medicare-covered benefits through a private plan.
Most Medicare Advantage plans also cover prescription drugs and may cover other services, like vision, dental and hearing. If you have Part A and Part B and are covered under the Original Medicare program, then you do not need to sign up for a Medicare Advantage plan during Open Enrollment unless you want to get your Medicare benefits through a private plan.
Medicare Advantage plans restrict the health care providers that enrollees see (provider networks) whereas beneficiaries in the Original Medicare may see any doctor that accepts Medicare, without needing prior authorization or a referral from their primary care doctor.
Start Your Research
Now is the time to research and make preliminary calls to get an idea of what changes (if any) need to be made to your Medicare coverage. Gathering information now will prevent you from making knee-jerk decisions at the end of enrollment. Here are six steps to take:
• Become familiar with each part of Medicare, Part A, Part B, Part C, and Part D. This glossary explains terms in the Medicare program, medicare.gov/glossary/. If you have a Medicare Advantage Plan (Part C), are you happy with it? Be sure to read all mail from the carrier which arrives in September and October.
• Look for any changes to monthly premiums, deductibles, copays and provider groups. If you have a Medicare Supplemental Insurance policy (Medigap), check for any changes or monthly premium increases. Some beneficiaries switch from Medigap to a Part C (Medicare Advantage Plan) at this time of year.
• If you’ve spent a lot of money out-of-pocket on hospital visits and doctor’s appointments because you don’t have a Supplemental insurance plan or Medicare Advantage Plan, add up expenses to know if a more coverage would help save money. Or check with Medicaid, a state Medicare Savings Program, the “Extra Help” program, or the local State Health Insurance Assistance Program (SHIP).
• Get up-to-date information on your health status. Is your annual visit with the primary care physician coming up? Will you need to see a specialist? Make a list of all your prescription medications. If any are brand name, ask the pharmacist if there are generic equivalent. If not, ask your insurance plan Part C or Part D for an exception if the expensive brand-name medication isn’t part of the drug formulary.
Carol Marak, aging advocate and editor atSeniorcare.com. She’s earned a Certificate in the Fundamentals of Gerontology from UC Davis, School of Gerontology.