What To Look For With Medicare Open Enrollment

Medicare Open Enrollment

Medicare Open Enrollment, the time when decisions are made regarding certain Medicare plans, began this year for 2019 on October 15 and will continue until December 7, 2018. The time is always surrounded by questions and concerns and the many glossy flyers consumers receive do not usually help in their decision making for what kind of Medicare insurance they want or need and the ups and downs of each choice.

If you have done this every year, you may have it down by now but a refresher is always useful.

First, note if you receive an unsolicited phone call like the one I received recently on voicemail which was repeated several times over various days, you probably realize it is deceptive. However, just in case, I will repeat the message I received on voicemail and warn you in advance. “Hi, this is Nancy, your patient advocate working with Medicare. This is your final notice. If you do not act soon Medicare will label you ineligible for coverage. Press one now to speak with me or another paid specialist…”

Ok. Medicare is not going to “label you ineligible for coverage.” That does not happen. Second, Nancy is not “your patient advocate” and she does not work for Medicare, the government agency known as Center for Medicare and Medicaid Services. Whoever “Nancy” works for is in the business of selling insurance.
Here are some facts you need to know.

  1. If you are happy with what you have and are currently on a Medicare plan generally speaking you do not need to change. As with everything there are exceptions. Premiums could have increased substantially or the plan you are on could have changed its benefits. Medications you use might not be listed on the new formulary for the plan. These are a few examples so you want to take a look at what you have. Consider carefully what you would be changing to.
  2. Before making any decision recognize what kind of plan you are on. If you are 65 or over, for instance, and especially if you still work full time for a larger employer it is quite possible the employer’s plan is primary and Medicare is secondary and you do not need to make any major decisions at this time.
  3. If your coverage is through yourself individually, know whether you have basic Medicare only or basic Medicare with a Medicare Supplement (Medigap) or if you have a Medicare Advantage plan. It is not always easy to tell. If your medication is included in the same plan as your doctor’s visits and hospitalization it is likely a Medicare Advantage plan although Medicare Supplement plans often pair with another company for their prescriptions. If you have letters associated with your plan like G, H, N, etc. it is probably a Medicare Supplement (look at your insurance card). If you have extras like dental, vision or Silver Sneakers, it is probably a Medicare Advantage plan.
  4. Once you know whether you have a Medicare Supplement or a Medicare Advantage, here are some of the considerations.

Open enrollment is primarily to determine whether you want to change from one Medicare Advantage plan to another Medicare Advantage plan. You can also change from one Medicare D (prescription drug plan) to another.

If you are just becoming eligible for Medicare (such as just turning age 65), you can sign up as soon as you become eligible regardless of the month and can choose whether you want a Medicare Supplement or a Medicare Advantage plan.

If you already have a Medicare Advantage plan and want to change to a Medicare Supplement you might not be able to later because, unless you are just becoming eligible, you would need to pass medical underwriting to qualify for a Medicare Supplement.

Sometimes individuals sign up for Medicare Advantage plans recognizing the premiums are often lower. When the same individual becomes seriously ill, he or she may discover that their Medicare Advantage plan is limited or would not be taken by certain doctors or hospitals. Medicare Advantage plans are limited to a given geographical area. So, if you have a plan in Pennsylvania and move to Ohio, for instance, you would apply for a different plan. Medicare Supplement insurance is accepted by any doctor or hospital that accepts Medicare.

If you are confused, get help. The Chester County APPRISE program staffed by volunteers, is excellent. It can be contacted at 610-344-6035.

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.

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