Medicare Open Enrollment: Are you prepared?

Medicare’s main open enrollment begins October 15 and ends on December 7 each year. During this time, Medicare participants get a chance to review their current coverage and can make changes if they desire. Open enrollment is for individuals who already participate in Original Medicare or Medicare Advantage.

What is Medicare and its different components?

Medicare is a federal health insurance program for people 65 and older, people with certain disabilities, and people with certain types of kidney disease or ALS.

Original Medicare (Part A & Part B)

Part A (Hospital Insurance)

o 100% coverage, subject to Part A deductible for hospital stays

o Covers hospital stays, skilled nursing facilities, and medical care provided in your home

o Monthly cost: $0.00 for individuals who have paid Medicare taxes for at least 40 quarters (10 years of work)

Part B (Medical Insurance)

o 80% coverage, subject to Part B deductible

o Covers doctor office visits, lab tests, and outpatient procedures

o Monthly premium cost: $148.50 - $504.90 based on prior year Modified Adjusted Gross Income (MAGI) (2021 rates; 2022 rates have yet to be published but will likely increase)

Medicare Advantage Plans (Part C)

o Medicare Advantage Plans combine Medicare Part A and Part B

o Sold by private insurance companies like BlueCross BlueShield, VIVA Medicare, Cigna-HealthSpring, etc

o Often also include Prescription Drug Coverage

o Physicians must be in Plan’s provider network; double check that your physicians are in the specific Advantage Plan network

o Monthly premium cost: Varies by plan; often $0.00 depending on plan. (Still responsible for the Part B monthly premium)

Part D

o Helps lower prescription drug costs

o Sold by private companies like BlueCross BlueShield, Humana, Express Scripts, etc.

o Drug coverage based on plan formulary

o Monthly premium cost: Varies by plan; you may have increased Part D premiums based on your MAGI

Medicare Supplement Insurance (also known as Medigap Policy)

o Helps pay some of the health care costs not covered by Parts A and B (Original Medicare); typically pays the 20% coinsurance that is left after Part B has paid its portion

o May cover medical costs while traveling abroad

o Sold by private companies like BlueCross BlueShield

o Monthly premium cost: Varies by plan

What are my choices?

Option 1

Original Medicare Card

Part A & Part B

+

Medicare Supplement (Medigap) Policy

+

Medicare Prescription Drug Plan

Part D

OR

Option 2

Medicare Advantage Plan

Combines all parts into one Plan

Part A + Part B = Part C

Part D coverage also usually included

During the main open enrollment (October 15 thru December 7) you can do the following:

· Switch whether you use Original Medicare or a Medicare Advantage Plan

· Move to a different Medicare Advantage Plan

· Join a Medicare prescription drug plan (Part D)

· Switch to a different Medicare prescription drug plan

· Drop your Medicare prescription drug coverage (I don’t like adding this one, thoughts on removing?)

What should I do?

1. Review your current coverage. Have you had a change in your healthcare needs or prescription medication in the last year? Does a new health situation warrant looking at different coverage options? Make sure the insurance provider (Medicare Advantage Plans and Part D plans) has not changed the policy from what you have been accustomed to.

2. Check your mail. Look for official correspondence from the Centers for Medicare & Medicaid Services (CMS) and your current insurance carrier (if you have an Advantage Plan, Medicare Supplement Policy, and/or Part D). You will receive a lot of promotional mail from other insurance companies before and during open enrollment, pay special attention to the pieces of mail that have pertinent information about your current coverage.

3. Utilize www.medicare.gov website for updates and information about coverage options. You can view all Medicare plan options on this website as well as review how your current plan has performed and how many starts Medicare has rated it. You can also call 1-800-MEDICARE to speak with a representative about original Medicare.

4. Don’t wait. Open enrollment ends on December 7th. If you want to make a change, you need to have your changes made before then.