For a few weeks every year, there is a period of time where the government allows people who receive health insurance to buy new insurance or make changes to existing benefits. This is known as Open Enrollment.
For Medicare specifically, open enrollment runs from October 15 to December 7. For those who wish to enroll in Medicare and those that are already in the program, Open Enrollment is crucial to ensuring that they receive the best coverage at the fairest rate.
What Is Medicare?
Medicare is a federally run health insurance program. Usually, anyone over the age of 65 who has paid Medicare taxes for 10 years is eligible, as well as people with disabilities. The main difference is that unlike Medicaid, Medicare is open to people at any income level. For more information about determining eligibility, the Medicare site has a convenient quiz here.
How is Medicare Split?
The Medicare program is split into four parts:
- Part A: Covers inpatient care in hospitals, nursing facilities, hospices, and in-home care.
- Part B: Covers outpatient care, doctor’s visits, durable medical equipment such as wheelchairs, and preventative care.
- Part C: Known as Medicare Advantage, this is a plan offered by private companies that covers Part A and Part B, and usually Part D as well. Some plans may have additional benefits.
- Part D: Covers prescription drugs. In order to get part D, one must add a drug plan to Original Medicare or otherwise join a Medicare Advantage Plan that carries drug coverage.
- Medigap: This is not a part of Medicare itself, but some private insurance companies offer extra insurance plans that help pay for Original Medicare costs.
From here, Medicare is split into two programs that a senior can sign up for to receive coverage. During open enrollment, seniors can switch between the two options or choose different plans.
- Original Medicare: Original Medicare covers Part A and Part B. To receive additional coverage, a senior can join a separate Medicare plan that covers Part D, and to help cover costs, a senior can also join a Medigap program from a private company.
- Medicare Advantage: Medicare Advantage covers Part A, Part B, and Part D, as well as extra benefits like vision, hearing, and dental services. This will often require seniors to use in-network providers, but can sometimes have lower costs than Original Medicare.
How to Enroll
First, compare the prices. Comparing Medicare plans is complicated, but can save a lot of money. Even if someone is already registered under a Medicare plan, their costs may vary every year. For those who are already enrolled in Medicare, their providers should have sent an Annual Notice of Change (ANOC) letter detailing any changes to their plans in the upcoming year. Besides that, anyone thinking of enrolling in a Medicare plan in the upcoming year should also consider the different costs of premiums, deductibles and copays, and of prescription drug costs. A helpful resource to determine costs can be found here.
Second, consider which providers, like doctors, hospitals, specialists, and pharmacies, are in the plan’s provider network. Costs are generally lower in-network, so making sure that as many of the health services a senior needs are covered will save the most money. If the provider that a senior currently uses has been excluded from the network for the upcoming year, it may be necessary to consider a different plan or carrier. On the other hand, if the majority of the providers that a senior currently uses are simply under another plan’s network, then it could be a good idea to stay with the same carrier and change to a slightly different plan.
Finally, if a senior has decided to enroll or change their plan, contacting a local Agency on Aging or browsing on the Medicare Plan Finder website will give them many options for next steps. If they enroll in Medicare Advantage and are dissatisfied with their plan, they may change it during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31.
What to Remember
You can eliminate the pains of health insurance by taking advantage of Open Enrollment. Doing so will help you pick the best plan for your needs while keeping costs low and the quality of care high. Don’t wait until the last minute to learn about Open Enrollment and understand it — your health and wallet will thank you for the extra effort you put in now!
