Understanding options with Medicare

Ask Ben: I’m Enrolled in Medicare. Is There Something I Need to Do this Fall?

In Ben Spec, Benefits and Employment Articles, Featured, News by Ben Spec

Fall in Wisconsin!  It may not be as exotic as Paris or Africa, but who can beat these gorgeous fall colors?  As I sit here admiring the beautiful fall leaves and enjoying the crisp air, I’ll answer a question about Medicare that comes along each fall….

Dear Ben,

I enrolled in Medicare when I first became eligible last May. I’ve heard that there is something I have to do each year around this time, but I’m not sure what that is. Can you help me understand what I need to do?

Jaylen


Hi Jaylen,

That’s a good question to ask, and this is a good time to ask it, for sure! The Medicare Part C and Part D Open Enrollment Period is October 15 through December 7 of each year. What you need to do depends on your current coverage, and how satisfied you are with it.

I’ll break down my answer to your question into the 4 different parts of Medicare, since each part is different:

Part A (Hospital Insurance)

There is nothing you have to do about your Part A coverage if you are already enrolled in Medicare.

Part A covers your hospital care, some of the costs if you’re in a skilled nursing facility, and hospice care for people who are terminally ill.

Part B (Outpatient Coverage)

There is nothing you have to do about your Part B coverage, also called “Original Medicare”.

Part B pays for doctor office visits, and outpatient hospital care and home healthcare which is not covered by Part A.

Part C (Medicare Advantage Plans)

During the Open Enrollment Period of October 15 through December 7 you can:

  • change from Part B Original Medicare to an Advantage Plan.
  • change from an Advantage Plan to Part B Original Medicare.
  • change from one Advantage Plan to a different Advantage Plan.

Medicare Advantage Plans are health plans that are part of the Medicare program but run by private insurance companies.  The services and costs of these plans vary widely, but all of them cover basic Medicare services.  Many of them cover more than the basic Medicare services and pay some of the costs not covered by Part B.

Your Medicare Advantage Plan provider should have sent you information in the fall to let you know of any upcoming changes to your coverage or costs.  Review this information to decide if you’d like to make changes to your plan.  If you haven’t received this information, contact your plan provider to request information.

Medicare Supplement Plans are another way to cover what Part B does not cover. You do not need to do anything during open enrollment if you have a Supplement plan and are happy with it. If you’re not happy with it, you can cancel it at any time and then enroll in an Advantage Plan during the annual open enrollment period.

Part D (Prescription Drug Plans)

The open enrollment period for Part D plans is also October 15 through December 7. During this period, you can:

  • enroll in a Medicare Prescription Drug Plan.
  • switch from one plan to another.
  • drop your Medicare prescription drug coverage completely.

Part D plans provide prescription drug coverage.  The plans can change each year, including the cost of the plan and drugs covered.  It’s important to look at your plan for the coming year to be sure it still covers the medications you need at a cost you can afford. Medicare.gov’s Medicare Plan Finder can help you with this.

Each fall you should receive a letter describing any changes to your Part D plan. Your Part D provider provides this information to you to help you understand any upcoming changes.  Be sure to review this information so you understand your coverage and costs.

I hope this helps, Jaylen. It’s not really as complicated as it looks. The most important things boil down to this:

Between October 15 and December 7:

  • review your “Annual Notice of Change”.
  • check your Part C and/or Part D coverages and costs for the coming year if you are already enrolled.
  • make changes to your existing coverage, if you choose.

Good luck, and I wish you good health, Jaylen!

Ben

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