This is an important time of year for older adults. Between October 15 and December 7 Medicare recipients can change their health insurance plan without penalty. Every year for almost two months, the federal government offers an “open enrollment” period when seniors can review, tweak their current policy or find a plan that better fits their needs.
During open enrollment recipients can switch from Medicare Part B (Original Medicare) to a Medicare Part C Plan (Medicare Advantage Plan). They may also switch from a Medicare Advantage Plan to Original Medicare or from one Medicare Advantage plan to another. During the same time period, participants can change or enroll in a Medigap plan and change their Medicare Part D prescription plan. Any changes that are made during open enrollment will go into effect on January 1, 2018.
Selecting the right plan can be stressful especially if you do not understand what each offers. To help you make an educated decision, here is an explanation of the A, B, C’s and D’s of Medicare choices during open enrollment.
Medicare is the federal government’s medical insurance plan that covers the cost of health care for most adults aged 65+. It may cover some younger individuals with special medical requirements as well. Medicare is divided into two parts. Part A covers hospitalization and nursing home care. Medicare Part B covers outpatient services. Medicare Part A is not one of the options that can be changed during open enrollment although some Medicare Advantage Plans limit you select hospitals.
Medicare Part B includes doctor visits, outpatient medical procedures, equipment and some medical tests such as HIV screening, mammograms, prostate cancer screening, flu shots and diabetes tests. Medicare Part B is a nationwide health plan with participating doctors located anywhere in the U.S. This can be a major advantage. A major disadvantage is that Part B does NOT cover most dental care, eye exams, hearing aids, alternative medicine, and cosmetic surgery and it does not subsidize prescription drugs. To acquire these services a participant must join a supplementary insurance plan called a Medigap plan and a Medicare Part D prescription plan.
Medigap Plans are health plans supplied by private companies that are designed to supplement Medicare. They cover copayments, coinsurance, and annual deductibles. The costs of theses plans vary, depending on what they offer. They all cover co-payment costs not covered by Medicare and can provide additional services such as vision, hearing, and dental care. Examples of some Medigap plans are AARP Medical Supplement, Humana Medical Supplement, and Emblem Health Medical Supplement.
Medicare Part C also called Medicare Advantage Plans are private health plans that are approved by the federal government. Some of the better known plans are Fidelis, United Healthcare, Aetna Healthcare although there are many more. Some of these plans offer their services at the same price as Original Medicare while others require higher premiums because they cover additional medical services like dental and eye care.
Advantage plans do not require participants to sign up for a Medigap or prescription plan. These services are usually included in the plan. This can be considered a benefit for seniors who do not want to shop around for supplemental services.
Advantage Plans do have a downside. These plans are usually local so if a member moves outside the coverage area, he will not find participating medical services. The same is true for hospitalizations. Participants are limited to using participating hospitals.
Medicare Part D is the federal government’s drug program that subsidizes the cost of prescription drugs for Original Medicare participants. Private companies that are approved by the federal government offer these plans. Each plan must offer a selection of medicines in specified drug categories called formularies. Some plans offer generics formularies instead of specific brand names, so recipients who are partial to taking a brand over a generic drug should check that their medicine is offered in their Part D plan.
What plan is best for you? This depends on your medical needs. Before you make a decision ask yourself the following questions: Will the new plan include your doctors and your medications? Can you afford payments? Does the plan include your hospital preferences? If you plan to move, will your plan still cover you?
Medicare’s open enrollment period is a great opportunity for every senior to customize his medical needs but it is important to do your research before switching or retaining a plan.