Understanding Medicare Open Enrollment
The rules regarding Medicare, the government’s health insurance program for senior citizens or those who have special needs, are confusing enough. The open enrollment period adds another layer of uncertainty for those who need the services offered. The term “open enrollment period” is also used for those signing up for the Affordable Care Act, so be careful not to confuse that period when you mean to sign up for Medicare or change your plan.
The Open Enrollment Period
The open enrollment period for Medicare happens once a year between October 15 until December 7. This is the period when you are eligible to change your Medicare coverage, and you also have the option to switch between different Medicare plans. During this period you can:
- Join a new Medicare Advantage plan.
- Join a standalone prescription plan.
- Switch from a standard Medicare plan to a Medicare Advantage plan.
- Switch from an Advantage plan to standard Medicare (with a prescription plan, as you’ll be losing the prescription coverage in your Advantage plan).
- Drop your prescription coverage.
Review Your Medical Coverage During Open Enrollment
You should take this opportunity given in the open enrollment period to review your current plan and look at other plans. Are there other plans that may be more beneficial? Are you getting the coverage you need? There may be other plans, especially prescription coverage, that pay more benefits and cost less than your current plan.
You shouldn’t have to do a lot of research to find out what coverage you have and what other plans are available. You will receive information from the government regarding your current plan, whether original Medicare or Advantage, each year. This will notify you of your current coverage and any upcoming changes if there are any.
There are tools available online or by phone to find out about other plans. Medicare offers a Plan Finder tool online or you can call 1-800-MEDICARE to find out about new Advantage plans in your area or to join. You can also visit the website of the State Health Insurance Assistance Program to find help in your state. Some states have their own website for their program, a call center and social media pages.
You should always talk directly with a representative from the insurance plan you want to pick before you sign up. They are likely to have the most current information. Call the doctors in those plans to make sure that they do in fact accept the insurance you’re planning to enroll in.
You may already be aware that Medicare doesn’t cover all of your medical expenses. Some states offer Medigap coverage, and the open enrollment period is the time to sign-up if you’re eligible. Medigap coverage will help you pay for things that standard Medicare doesn’t cover, like co-pays or some procedures or deductibles.
Missing the OEP Deadline
If you want to make changes during the open enrollment period, but miss the deadline, you will have to wait until the next period to make changes to your plan. You may be eligible to make changes under the Special Enrollment Period under certain circumstances. These circumstances include losing enrollment in an insurance plan that is better than Medicare’s plan or you lose coverage of an employer-sponsored program. Additional circumstances are listed in the government’s guide to special enrollment situations.
Medical expenses can cause us to dip deeply into our savings. It is beneficial to shop around for the Medicare plan that best meets our needs, especially for seniors living on a fixed income.
Feel free to reach out to one of our experienced Medicare specialists by using this link:
PBC Insurance - Medicare Specialists
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