How to Navigate Medicare Open Enrollment
The solicitations sometimes come with glossy color photographs of vigorous older men carrying surfboards and sporting wetsuits or you might receive a postcard inviting you to a meal at a restaurant or maybe just an informational meeting. It is time as it is every year in the Fall for Medicare Open Enrollment, the period that runs from October 15 to December 7 when Medicare beneficiaries may decide their plans for the following year. The solicitations come from specific companies, of course, advertising their plans.
If you are confused, you are not alone. In fact, there are now brokers to assist in deciding the best plan for Medicare beneficiaries and many of these people are knowledgeable and are not tied to any particular company or type of plan. It may be worth consulting one such expert or you might also talk to our local APPRISE group, an impressive group of volunteers who offer their services free of charge. Liz D’Angelo has been the head for several years. They can be reached at 610-344-6035. In the meanwhile, here are some general ideas that might help you navigate the maze.
- Medicare Open Enrollment Is Not Obamacare. You probably already know this but, to clear the air, it helps to recognize that Medicare Open Enrollment is not covered by or related to Obamacare. Medicare beneficiaries already have insurance. Open Enrollment occurs every year and is not related to the on-line issues for Obamacare.
- You can keep the coverage you now have if you are satisfied. This obvious statement but bears repeating. If you are fully satisfied with your current coverage and do not anticipate any changing health care needs, you do not need to change simply because you receive a stack of offers in the mail. If you feel comfortable tossing the flyers, that is one more source of clutter out of your life. However, if you want to explore further, you can.
- The first important step is deciding whether you have or want to have a Medicare Supplement (Medigap) Plan or a Medicare Advantage Plan. Medicare Supplement (Medigap) is the basic Medicare program plus private coverage to handle co-pays, co-insurance and out of pocket costs. The types of Medicare Supplement plans are given letter names. Medicare Supplement plans “A,” “B,” and “C,” for instance, (not to be confused with Medicare A,B and D) while less expensive, provide less coverage. Medicare Supplement “F” has the highest level of coverage but is generally extremely expensive. Less expensive but popular and with good coverage are Medicare Supplement “G” and “N.”
Here are some things to know about Medigap coverage:
- If you chose a given “letter” coverage, all plans with that letter with all companies have the same benefits. The only differences are quality of service provided by the company and cost.
- If you have Medigap coverage, it is accepted by every physician, hospital and medical provider that accepts Medicare.
- Medigap coverage continues to cover if you move to another State or area of the country.
- If you initially sign up for a Medicare Advantage plan and later want to change to a Medigap plan, you will likely have to undergo medical underwriting to change.
- Medigap coverage does not include prescription drug coverage but a separate prescription drug plan (PDP) is often recommended separately.
Here are some things to know about Medicare Advantage.
- Medicare Advantage plans usually can be changed only once a year. If you change from one Medicare Advantage plans to another, you need to do this during the “Open Enrollment Period” which begins October 15 and ends December 7 to take effect January 1.
- There is a wide diversity of coverage among Medicare Advantage (HMO, PPO, PFFS) plans. Some plans offer wellness, hearing, vision and dental coverages. Some do not. Some commute well between States, that is the coverage is accepted in other States. Others do not. PPO’s usually commute better than HMO’s. Some require referrals and/or in-network providers. Some allow services without primary care physician referrals and out-of-network providers are covered but usually at higher cost.
- Medicare Advantage plans often include prescription drug coverage. Medicare Advantage plans are often packaged with prescription drug coverage.
Ask for assistance if you need help. You will not be the only one.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.