Navigating Medicare Open Enrolment: What You Need to Know

Medicare open enrollment is a crucial period when beneficiaries can review and make changes to their Medicare coverage if they so choose. Understanding the open enrollment process and available options is essential for ensuring individuals have the right coverage to meet their healthcare needs.

This guide was designed to provide valuable information and instruction to help individuals navigate Medicare open enrollment successfully.

TO BEGIN 

Medicare, which originated in 1965, is a federal program designed to provide health coverage and financial security to Americans age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.

There are four types of Medicare – Part A, which provides hospital coverage; Part B, which provides outpatient medical coverage; Part C (aka Medicare Advantage), which is an additional insurance option offered through private insurance companies that contract with Medicare; and Part D, which is prescription drug coverage.

The three requirements for Medicare eligibility are that an enrollee is 65 years of age or older, is a U.S. resident, and is either a U.S. citizen or an alien who is lawfully admitted for permanent residency and has lived in the U.S. for at least five years prior to the month of filing for Medicare. 

Original Medicare is a fee-for-service plan that provides hospital insurance (Part A) and medical insurance (Part B). After the enrollee pays the deductible, Medicare pays a share and the enrollee pays any coinsurance. 

For those already receiving Social Security benefits, he or she will automatically be enrolled in Medicare Part A and Part B, beginning the first day of the month they turn 65. Those under 65 with a disability will automatically be enrolled in Parts A and B after they’ve received Social Security for 24 months.  

MEDICARE OPEN ENROLMENT 

refers to an enrollment window that typically occurs from October 15 to December 7. During that time, as an enrollee, you can reevaluate your existing coverage and make changes if you desire. All four parts of Medicare are available within the open enrollment window. 

When considering your Medicare options during this period, think about coverage details such as out-of-pocket costs, prescription drug coverage, possible upcoming doctor appointments or procedures, even travel plans. Original Medicare typically does not cover healthcare services in other countries, so you may want to purchase a supplemental plan, in case of emergency.

Enroll online by way of the Social Security website, by phone or in person. No matter which way you choose to apply, you will need to have certain documents on hand including your birth certificate, proof of citizenship or legal residency, your social security card/number, health insurance information, tax information and military documents if applicable.

ONCE ENROLLED 

in original Medicare, you may choose to change or add coverage such as Medicare Part C, more commonly referred to as Medicare Advantage.  

With Medicare Advantage, you will receive standard Medicare services, and possibly some care not offered with the original option including dental, vision and hearing care.

In most cases with the Advantage plan, you will be able to visit only doctors who are in the plan’s network, and in some cases, you may need plan approval before it will cover certain drugs or health care services; however, the Medicare Advantage plan may have lower out-of pocket costs than original Medicare. It’s important that you review provider networks for Medicare Advantage plans to ensure that preferred doctors, hospitals, and specialists are included in the plan’s network.

While Medicare Parts A and B comprise hospital and medical insurance, Medicare Part D covers prescription drug costs. And while all Part D drug plans are required to cover a range of prescription drugs, including drugs to treat cancer and HIV/AIDS, each has its own list of covered drugs. This list, known as a “formulary,” includes both brand-name and generic drugs. All Medicare Part D plans must cover at least two drugs per drug category, but plans can choose which drugs they will cover. 

Payments for Part D drug coverage are made through monthly premiums, annual deductibles, and copayments or coinsurance. Most Medicare Part D plans have a coverage gap, commonly referred to as a “donut hole,” which means there is a temporary limit on what the plan will cover. Part D is financed through premiums, deductibles and tax revenue, and costs vary by plan and location.

BE SURE TO FAMILIARIZE 

yourself with your options when choosing a Medicare plan. Weigh the benefits, consider the costs of monthly premiums, deductibles, coinsurance and copayments. Also consider coverage, especially for specific services or condition. Remember, Medicare has limited coverage of services or supplies outside the U.S. 

For more information, visit Medicare.gov, where you will find the Medicare Plan Finder tool, which will allow you to explore your plan options. Once you choose a plan, review the Summary of Benefits and Coverage, and if you still have questions, don’t hesitate to call plan representatives directly.