Medicare Open Enrollment: How to Stop Medicare Choice Confusion

It’s choice time for Medicare again, also known as Medicare open enrollment. If you are just getting involved for the first time or even have had coverage from it, it can be a very confusing time in your life.

Doctor in exam room representing Medicare open enrollment

Medicare, our national health insurance program here in the United States, began in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services. It primarily provides health insurance for Americans aged 65 and older. But it also covers some younger people with disability status as determined by the SSA, including people with end stage renal disease and amyotrophic lateral sclerosis.

If you are confused by Medicare and your choices, then you need to get answers before you sign on any dotted line. That’s why I am writing today about some of the questions you need answers to when it comes to Medicare choices.

What Are You Looking for in Healthcare Needs Right Now?

It can be difficult to get your arms around Medicare when you’re learning about it or even when you’re already a Medicare beneficiary who wants to learn about the possibility of changing plans.

If you’re nearing retirement age, healthcare usually is uber-important. Trying to learn about Medicare, even if you are already a Medicare beneficiary wondering about the benefits the commercials on TV advertise, you can get easily confused and overwhelmed.

Now we are about to enter Medicare open enrollment, the time when choices need to be made about your Medicare plan. From October 15, 2021 to December 7, 2021 you have the opportunity to sign up for a new plan or just keep your old one if you are already enrolled. But how do you decide?

What You Need to Know When Making Your Decisions

Check out these Q&A’s that give a high level of the differences between traditional Medicare and Medicare Advantage plans. As you begin learning about Medicare, you should ask yourself these questions:

1. Is Medicare coverage the same for everyone?

No. There are two ways to get your Medicare coverage. You can go with traditional Medicare’s fee-for-service (Part A and Part B, with the option to enroll in Part D for prescription drug coverage). This gives you the option to take out Medicare Supplement insurance (also called Medigap) coverage to help fill in the gaps left by traditional Medicare. Traditional Medicare generally covers about 80% of your Part B services. Or, you can go with the managed care approach of Medicare Advantage (Part C).

Medicare Advantage is the alternative to traditional Medicare, meaning you surrender Parts A and B, along with the option to buy Medicare Supplement insurance. Medicare Advantage is offered by private insurers to offer comparable services to traditional Medicare, and generally includes prescription drug coverage and some other benefits.

2. How do I determine which plan is right for me?

Ask yourself these specifics before you decide on traditional Medicare or a Medicare advantage plan.

a. Is keeping your doctor or specialist important to you?

If you’re like most people, you have a doctor or specialist you trust. Medicare Supplement plans allow you to use any doctor that participates in Medicare (most do) and you don’t need a referral to see a specialist.

With Medicare Advantage plans, you might have restrictions on which doctors you can see (such as a participating network). You may also need a referral to go to a specialist.

b. Am I going to do a lot of traveling?

With Medicare Supplement plans, you’re covered anywhere you travel throughout the United States. Depending on your Medicare Advantage plan, you may not get coverage in some areas.

c. Do I need help in paying for my prescription drugs?

Many Medicare Advantage plans help cover prescription drugs. While Medicare Supplement insurance does not cover prescriptions, you can find a separate Part D prescription drug plan to fit your needs.

d. Do I want to keep the coverage I choose forever?

Medicare Supplement coverage is guaranteed renewable for life. The company can’t cancel your plan as long as you continue to pay the premiums.

Medicare Advantage coverage, on the other hand, is not guaranteed renewable. The company may change or cancel your plan each new calendar year, which means you may have to shop for coverage again.

In fact, I recommend that you do shop every year for a new plan that might be better than the one you currently have or may have new and better benefits and may even be cheaper (or have zero premiums) than the plan you now have.

e. What is my budget for medical coverage?

A Medicare Advantage plan can cost less in premiums today, even a zero cost plan is possible, but your out-of-pocket costs are usually higher. If your budget will allow for these expenses, then Medicare Advantage could be an option for you.

Depending on the Medicare Supplement plan you choose, you may have a higher premium, but it can typically cover a larger share of your health care bills, meaning you’ll have fewer out-of-pocket costs.

3. So now that open enrollment is here, what do I need to do?

Medicare’s annual open enrollment period runs from October 15th through December 7th. Among the changes you’re allowed to make during this time are that you can switch from a Medicare Advantage plan back to traditional Medicare, switch from one Medicare Advantage plan to another one, join a Medicare Prescription Drug Plan (Part D), or switch from one Medicare drug plan to another one.

Important to remember and keep in mind:

If you already have Medicare Supplement coverage you’re happy with, you don’t need to do anything during open enrollment except consider a review of your prescription medication coverage (Part D).

Final Thoughts

This is crunch time and the time you need to decide what you will have as your coverage for the next year. That’s why asking these questions is so important. You need to understand about at least seven things when choosing coverage.

They are the cost, the coverage, any other insurance coverages you may have and how it will interact, your prescription drug needs, your doctor and hospital choices, the kind of quality of care you desire, and whether you will be traveling frequently.

One misconception that some people have is that Medicare will cover all of your health needs. It doesn’t cover everything. Some of the items and services Medicare doesn’t cover include: long-term care (also called custodial care), most dental care, eye exams (related to prescribing glasses), dentures, cosmetic surgery, acupuncture, hearing aids (and exams for fitting them), and routine foot care.

There is a lot riding on your choices, so use this time right now to get the answers you need to these questions. Check out the Medicare.gov website for great information before you make your decision.

Are you worried about medical coverage as the Medicare open enrollment season arrives? What questions do you need answers to or are you ready to make this important choice now?

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