Categories: Medicare

How to Get Ready For Medicare Open Enrollment

Each year, Medicare open enrollment runs from October 15-December 7. This is the time when individuals age 65 and older can make changes to their healthcare and drug coverage to better fit their medical needs for the coming year.

Individuals currently enrolled in Medicare should receive documents in advance of open enrollment that explains any changes that will affect their coverage for the following year. If you have received document and the changes no longer meet your medical needs, or you wish to change the level of coverage you currently have, open enrollment is the time to make updates for things such as:

  • Changing from a regular Medicare plan to Medicare Advantage
  • Doing the opposite, and changing from Medicare Advantage to a regular Medicare plan
  • Switching from a Medicare Advantage plan that doesn’t offer prescription drug coverage to one that does
  • Downgrading from a Medicare Advantage plan that offers drug coverage to one that doesn’t
  • Enrolling in a Medicare Prescription Drug Plan (Part D)

If changes are made, they go into effect on January 1. If you don’t turn 65 during the open enrollment months, you can enroll in Medicare three-months before your 65th birthday and do not need to adhere to the open enrollment rules.

Understand the differences of Medicare coverage

Regular Medicare is also referred to as Part A (hospital coverage) and Part B (medical coverage). Part C is Medicare Advantage, which is Part A and Part B of Medicare, but provided by a private health insurance company and not the federal government. If you wish to gain more coverage to pay for the costs that Medicare doesn’t cover, you can purchase a Medicare supplement plan to enrich your overall medical insurance coverage. (Note: You cannot have Medicare Advantage and Medicare supplement insurance. If you have Medicare Advantage and wish to buy supplement insurance, you must revert back to regular Medicare in order to buy a supplement plan.)

Ask the right questions

  • When looking at a new Medicare plan or reviewing your current coverage, there are specific questions you should keep in mind to make sure you enroll in the best coverage for your specific lifestyle situation.
  • Does your current Medicare coverage cover all of your needs, or do you need to add additional coverage or supplement?
  • How much are you spending each year out of pocket for medical care? Could a different plan lower your costs?
  • How much are you spending each year out of pocket on prescription drugs? Could Plan D lower your costs?
  • Does your preferred doctor or hospital still take Medicare patients?

If you are happy with your medical and prescription drug coverage, you do not need to make any changes. But it is still wise to review your coverage each year.

One effect that will impact the Medicare program broadly in the future is a move to value pricing. Beginning in 2016, payments to providers will be based on outcomes from an event. As an example, if an individual has heart bypass surgery, the “value” of Medicare paying the provider will be based on the patient’s outcome. Did they recover well? Or was the patient readmitted to the hospital with complications? Providers will be required to report final outcomes of specific events to satisfy Medicare paying for the service a patient received. By the end of 2016, 30% of payments to providers will be value based. By 2019, 50% of payments will be based on outcomes. While this doesn’t affect you personally, it could change the provider landscape if doctors decide to dump Medicare patients to avoid having to report medical outcomes.

Get guaranteed acceptance into Medicare supplement

During the Medicare open enrollment period you can enroll in a Medicare supplement plan and avoid any health questions. You can enroll in a Medicare supplement plan outside of open enrollment, but you will be subject to medical review in order to gain acceptance. However, Medicare supplement, also known as Medigap,  can help contain medical costs, and offers additional protection that regular Medicare does not, like providing health coverage while traveling outside of the United States.

To learn more about Medicare or ask questions about your current coverage, call 1-800-MEDICARE or visit Medicare.gov.

Colleen McGuire: Colleen McGuire is an independent consultant who has spent most of her career writing about healthcare and the health insurance industry. For fun she blogs, travels and takes a lot of pictures along the way.

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