How to Navigate Medicare Open Enrollment Time
I love fall. It is my favorite time of year. I am also not 65 and don’t have to think about Medicare coverage.
Open enrollment in 2021 for plans effective in 2022 runs from Oct. 15 through Dec. 7.
Medicare coverage is complicated. For many, reviewing current plan coverage and making a change brings uncertainty and confusion.
If you are unfamiliar with Medicare terminology, here’s a quick primer:
Original Medicare Part A (hospital insurance) and B (medical insurance). You pay a part, generally 20%, and the federal government pays a part. There is no maximum out-of-pocket limit. Drug coverage is separate and covered by Part D (prescription drug coverage). If you are a high health care user, you will want to add either a Medigap policy or enroll in a Medicare Advantage Plan.
Supplement plans (Medigap). Supplement plans are sold by private insurance companies and are not a part of Medicare. They don’t replace original Medicare; you still need to have Medicare Parts A and B.
Medigap policies will cover many of the co-insurance costs of Original Medicare. In addition to the Medigap premium, you still pay the Medicare Part B premium. Medigap policies are standardized and identified by letters like Plan G or Plan K. There are also Medigap policies identified by A, B and C. These Medigap plans should not be confused with Medicare Part A, B, C or D.
The benefits in each lettered plan are the same in any plan with the same letter, no matter which insurance company sells it. Starting in 2020, Medigap plans sold to new enrollees no longer cover the Part B deductible. This means Plans C and F are no longer available for new enrollees. Depending on when you enroll you may be subject to underwriting.
Medicare Advantage (Medicare Part C). Combines Parts A and B and sometimes includes Part D. Run by private health insurance companies and operates on a co-pay with an out-of pocket limit.
Medicare Advantage replaces original Medicare and connects all the pieces together in one plan. Some plans may include additional benefits such as vision, dental and gym membership. Downside is that each plan has a specific network of providers and facilities, and you’ll need to check if your providers are “in-network.”
It is easy to assume that the coverage you picked last year will work again this year. Medicare Advantage and Part D prescription drug plans can change significantly from year to year. Medigap policies tend to be more stable. In addition to policy changes, your situation may have changed. Common factors that warrant more than a cursory review include any changes in:
◗ Health care usage.
◗ Your health care provider or facility.
◗ Location or travel patterns.
◗ Your prescription drugs.
In any of these circumstances, not reviewing your plan could open you up to unexpected cost or gaps in coverage.
When moving from a Medicare Advantage Plan to a Medigap policy, keep your Medicare Advantage plan in place. Your Medigap plan may be subject to underwriting and if you don’t qualify, you may be exposed to higher costs or penalties.
I have a few years until I am Medicare eligible, so I keep learning and looking for reliable resources. Favorite resources are Medicare.gov and the State Health Insurance Assistance Program. SHIP provides unbiased, one-on-one counseling. Local Indiana offices can be found at in.gov/ship/find-an-indiana-shiplocation/.
With the right help, organization and patience, it is possible to find a plan to fit your unique situation.