Medicare Open Enrollment

October 15 through December 7

The Medicare Open Enrollment period begins October 15 and run through December 7. During the enrollment period, Medicare recipients can change Medicare Advantage plans, switch from traditional Medicare to a Medicare Advantage Plan, or switch from a Medicare Advantage Plan to traditional Medicare coverage. The following information is designed to help people better understand these options and to learn where they can find more detailed, unbiased, information on their options.

Traditional Medicare Coverage- Traditional Medicare Coverage is comprised of three parts: Hospital Insurance (Part A), Medical Insurance (Part B), and Prescription Insurance (Part D). Part A is provided to people age 65 or older who is eligible for Social Security or Railroad Retirement benefits. Part B has a premium, which is deducted from your Social Security or Railroad Retirement monthly benefit before you receive it. Part D is purchased through insurance companies; these premiums may be paid directly to the insurance company or deducted from your Social Security or Railroad Retirement benefit. Because there are deductibles and co-pays with traditional Medicare, it is wise to purchase supplemental insurance. These policies are known as Medigap policies. Medicare requires all companies offering Medigap policies to standardize their policies. The policies are categorized by capital letters, and insurance companies must provide identical coverage for each “letter” category. This enables you to easily compare prices. Go to Medicare’s website, www.medicare.gov, click on the “Supplements and Other Insurance” tab, then click on “Find a Medigap Policy,” and follow the directions to obtain a list of available insurance companies providing Medigap policies for your area. With a Medigap policy you will have two insurance cards (Medicare and Medigap).

It is important to show both cards to medical providers to be sure claims are filed with both insurances. If your Medigap policy does not include prescription coverage, you can also purchase a Part D policy from participating insurance companies; you would use that card for any prescriptions. If you follow the directions in the next section for “Find Health and Drug Plans,” you can obtain information on participating companies in your area.

Medicare Advantage Programs– Medicare Part C is the Medicare Advantage Program. Here an insurance company contracted with Medicare combines the traditional Medicare coverage with supplemental coverage, and it issues a single policy under that insurance company. There are a variety of Medicare Advantage plans: Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Point of Service Organizations (POS), and Private Fee for Service (PFFS). With some Medicare Advantage policies you may incur a financial penalty if you use an out-of-network provider, or fail to obtain authorization from your primary care physician for certain treatments. Go to Medicare’s web site, www.medicare.gov, click on “sign up/change plans,” then click on “Find Health and Drug Plans,” and follow the directions to find insurance companies offering: drug coverage, Medicare Advantage coverage, or both. With a Medicare Advantage Policy you do not use your Medicare card. You only use the card Issued by the insurance company since it combines your Medicare and supplemental coverage into a single policy.

Enrollment Period- In most circumstances you are allowed to drop or switch a Medicare Advantage Plan only during the enrollment period (October 15 to December 7). The “Medicare & You” handbook listed on Medicare’s website gives information on exceptions to this. To get the handbook go to Medicare’s website, www.medicare.gov, click on “Help and Resources,” and then click on “Publications.”
Questions to Consider During the Enrollment Period-

1. Does your present or former employer provide part or all of your health insurance coverage, either as a Medigap policy or as a Medicare Advantage policy? If the answer is yes, you may incur premium costs if you switch from your employer’s plan to another plan.

2. Do you travel frequently outside your local area? Or, do you spend extended time during the year outside your local area? If the answer to either question is yes, and you would like a Medicare Advantage policy, you would be wise to find out how the insurance company handles medical claims when you are outside their network of local providers. While they will have provisions for emergency medical care, routine medical care may be problematic.

3. If you want to switch from traditional Medicare to a Medicare Advantage policy, or if you want to switch Medicare Advantage companies, you would be wise to check if the new insurance company has a network of preferred providers. Some Medicare Advantage policies have financial penalties if you go outside their network of providers. You may also want to check if your current medical providers are in the new company’s network of providers.

Sources of Help- During the enrollment period many insurance companies offer free information and seminars. The information may be factual, but the sales people can only tell you about the policies offered by their company. For unbiased information, check out all the information on Medicare’s website. Medicare not only gives you listings of the companies providing policies in your area, but also rates these policies. The APPRISE program through the PA Department of Aging (1-800-783-7076) also provides help with health insurance questions. The APPRISE program utilizes trained volunteers with whom you can meet to have them explain your Medicare options.