(BPT) – Fall and winter don’t just bring cooler temperatures and the holidays – the final seasons of the year also mean open enrollment for Medicare. For most seniors in the United States, the period between Oct. 15 and Dec. 7 is the only time they can switch or make changes to their Medicare insurance plan.
‘As people age, their health care needs evolve,’ says Dawn Maroney, chief growth and strategy officer for Alignment Healthcare. ‘When that happens, they may find the Medicare plan they first chose when they became eligible no longer meets all their needs. This open enrollment period is their yearly opportunity to re-evaluate whether to continue with their plan or switch to another, with changes becoming effective the first of the new year.’
Medicare basics
Most Americans are aware that Medicare is a government program designed to ensure people older than 65 have access to affordable health insurance. The program can also cover people younger than 65 who have certain disabilities.
The Medicare program has four parts, according to Medicare.gov: A, B, C and D.
* Medicare Part A helps pay for in-patient hospital stays, care in a skilled nursing facility and hospice care.
* Medicare Part B helps cover care by doctors or other health care providers, outpatient services, some medical equipment and some preventive services.
* Medicare Part C (also known as Medicare Advantage) covers everything included in parts A and B, and usually includes Medicare prescription drug coverage as part of the plan. Medicare Advantage plans may include extra benefits and services for an extra cost. Medicare-approved private insurance companies, such as Alignment Healthcare’s Alignment Health Plan, run Medicare Advantage plans.
* Medicare Part D helps cover the cost of prescription medications and is run by Medicare-approved private insurance companies.
Original Medicare versus Medicare Advantage
Most people think of Medicare parts A and B as Original Medicare, in which the government pays directly for the health care services received. People with Original Medicare can see any doctor and hospital that accepts Medicare in the country, without prior approval from Medicare or their primary care physician. Most people do not pay a monthly premium for Part A if they paid taxes while working; everyone pays a monthly premium for Part B, based on income. The standard premium for Part B in 2017 was $ 134 per month, which is deducted from the individual’s Social Security benefits.
Original Medicare pays for about 80 percent of the total costs of health care. The patient is responsible for the remaining 20 percent, which can mean high out-of-pocket costs in the event of a hospitalization or other events requiring significant medical attention. To offset the financial burden of that 20 percent, some people choose to purchase supplemental insurance, called Medigap.
Private insurance companies offer Medigap to cover things Medicare doesn’t, such as deductibles, co-pays and co-insurance – but, keep in mind, Medigap only supplements Original Medicare benefits. Further, if you do not apply for Medigap in the first six months of becoming eligible, there’s no guarantee that an insurance company will sell you a Medigap policy.
With Medicare Advantage, government-approved private companies administer health plans that cover everything Original Medicare does, but can do so with different rules, costs and restrictions that can change every year. For example, a private Medicare plan may require your physician to request permission before performing a procedure in order to be paid by the plan. Medicare Advantage plans, however, usually cover extras that Original Medicare does not, like dental care, vision services, hearing exams and gym memberships.
Most Medicare Advantage plans also include prescription drug coverage (Medicare Part D), which is not included in Original Medicare, at no additional cost. If you elect to enroll in a Medicare Advantage plan, you still have Medicare – this means that you must still pay your monthly premiums for parts A and B, in addition to a monthly premium for Part C, if applicable. Many Medicare Advantage plans are available for no additional monthly premium.
Considerations when choosing
When choosing between Original Medicare and Medicare Advantage, you should consider these questions:
* How likely is it your health needs will change down the road? Since health changes as you age, chances are your treatment needs will, too. If you don’t enroll in the additional insurance and drug coverage when you first sign up for Original Medicare, you may pay a monthly penalty for enrolling later and may not be eligible for additional Medigap coverage.
* Are you still working past age 65? If so, you will probably want to enroll in Part A, because there generally are no monthly premiums, and it may supplement your employer’s insurance plan. You might choose to delay enrolling in Part B, but it depends on your health coverage. Everyone has to pay a monthly premium for Part B.
* Is it more important to you to have lower or no premiums or lower out-of-pocket costs? With Original Medicare, you may pay more out of pocket without supplemental insurance and prescription drug coverage. Medicare Advantage includes supplemental insurance and sometimes prescription drug coverage, too.
* How important is it to keep your doctor? Original Medicare is accepted by any doctor or hospital that accepts Medicare, without referral. Medicare Advantage plans allow you to select a doctor from the plan network, which is usually very large; your current health care providers are likely to be in the network already.
* Do you regularly take prescription medication for chronic conditions? Prescription drug coverage is not included in Original Medicare, and if you fail to sign up for Part D at the time you enroll, you could pay a penalty for adding it later. Most Medicare Advantage plans do cover prescription drugs.
‘Medicare Advantage allows patients to receive the care they need to stay well and keeps their budgets in check with set costs and annual maximums,’ Maroney says. ‘It’s an ideal solution for patients who need frequent care or who struggle to meet medical expenses.’
To learn more about Medicare, visit www.Medicare.gov. For information about Alignment Healthcare and its affiliated Medicare Advantage plans, visit www.alignmenthealthcare.com.
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* http://SeniorSavingsNetwork.org 1-800-729-9590
This explains how to find the BEST Part D drug plan for seniors when turning 65 or during the Annual Election Period.
For complete, unbiased help in obtaining the lowest total cost Part D plan, you really must go through the Medicare.gov Plan Finder tool OR (better) use their call center which is open 24 hours a day.
The best tip is to call the call center late at night, so that you do not have to wait on hold.
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Hi Christopher, My name is Cathy. I live in Seminole County Florida. Could you recommend the best Medicare Advantage plan for my area. I am thinking about Aetna.
Just ran across your Medicare videos. Wow, what a help! Are you licensed in Washington State? I just applied and was approved for Medicare A and B (I turn 65 in June). I received information from my financial advisor that Cigna/Loyal American Life Insurance Company is the least expensive Plan G in Washington this year but wondered if you might have another suggestion. My zip code is 98329. I think I can figure out the Part D part via your instructions, so I will give that a try. I presume that is a necessity even though I take only 3 medications that aren't particularly expensive. Is there another plan that would provide dental insurance as well? Thanks for your help and BIG thanks for your public service via your videos! Vonda
Great video…super-informative!
Part D is so deficient it seems. How is someone supposed to know what drugs they will need a year from now? What if you get cancer, serious heart attack? Tier 5 drugs now can cost a fortune right, and apparently driving many into bankruptcy.
Are you licensed in Florence Kentucky?
I am 59 and on disability I have medicare Part A@B but I want to get part D to help pay for my prescription but would the best way to go
Christopher, Are you licensed in Oregon? Thank you for your input .. Very valuable
Excellent! Info I was looking for. Thank you, Christopher.
I am 59 and on disability, should I be looking at plans the same way someone 65? Thanks! Ann Marie in CT
Hi Christopher I turn 65 in Dec I am in good health I do not take any drugs do I need to get part D and why
yes very good
Turning 65 the day before Thanksgiving. Health – only take topical psoriasis creams (and Rx only when I have an ailment, which is rare). Would I be safe going with the lowest monthly fee Plan D for the time being? I'm a self-employed widow (on late husband's Social Security) so I pay all my own expenses.
Cool Advise Christopher , what about January 2017 if this Medicare insurance plans are scraped , is there any alternatives left?
Are you licensed in Nevada?
Great Help, Thank you!
Chris, I have enrolled in Medicare which will be active when I turn 65 this July. I'm now looking to sign up for the Part D drug plan I have been trying to get into the medicare plan finder site to look at drug plans but that site has a lot of issues. I called Medicare and three people told me they were big issues with Medicare.gov site. Please can you direct me to the site I need to look at Medicare Part D drug plan finder? You are much appreciated…Thank you!!