Open Enrollment for Medicare is a period of time in the fall where you can change certain aspects of the Medicare plan. To understand more about Medicare and Medicare Advantage Plans, take a look at the following article from the Social Security Administration. During Open Enrollment period, individuals can,
Change from Original Medicare to a Medicare Advantage Plan
Change from a Medicare Advantage Plan to Original Medicare
Change their Medicare Advantage Plan
Join, change, or cancel Medicare Drug Plan (Part D)
Original Medicare encompasses Part A and Part B. Generally speaking, Part A covers inpatient hospital care such as in-patient hospital stays, critical treatments, and visits to skilled nursing facilities, whereas Part B covers outpatient services such as some preventive services and ambulance services. However, Medicare Advantage Plans (also known as Part C) is an insurance option offered by private insurance companies that have Part A and Part B benefits in addition to certain other benefits such as prescription drug (Part D), vision, and dental coverage. Although rare, if a Medicare Advantage Plan does not have drug coverage, you may want to consider joining a Medicare Drug Plan. Premiums vary between Medicare Advantage plans.
If you already have a Medicare Advantage Plan, there is an additional enrollment period called the Medicare Advantage Open Enrollment Period (MA OEP) which takes place from January 1st to March 31st. During this period, eligible individuals can,
Change their Medicare Advantage Plan
Change from Medicare Advantage Plan to Original Medicare
Importantly, individuals cannot change from Original Medicare to a Medicare Advantage Plan during MA OEP.
When Does Open Enrollment Occur?
The Open Enrollment Period for Medicare is from October 15 to December 7th. If you already have a Medicare Advantage Plan, the Medicare Advantage Open Enrollment Period takes place from January 1st to March 31st.
Why It Matters
Medicare Open Enrollment is one of the most important times of the year for anyone covered by Medicare. The choices you make during this period can directly affect your health coverage and out of pocket costs for the next year. Because plans can change premiums, benefits, drug coverage, and provider networks each year, reviewing your options is essential for not paying more than necessary or missing out on benefits you need.
Who should pay extra attention during Open Enrollment:
Anyone whose plancosts or copays increased
Anyone who have new or changing health conditions
Anyone who started new medications or prescriptions this year
Anyone who moved to a new area (since plan networks vary by location)
Anyone who qualified for Extra Help or a Medicare Savings Program this year
Anyone who just wants to see if there’s a better option
Failing to review or make changes during this time can mean being locked into a plan that no longer meets your medical or financial needs until the next enrollment period. It’s a good idea to take a few minutes to compare your options, especially if your prescriptions, preferred doctors, or income have changed. Doing so can help you avoid surprise costs, keep access to your providers, and make sure you’re getting the best value for your coverage.
How to Prepare
The following are some key steps you can take as an Open Enrollment Period and Medicare Advantage Open Enrollment Period approach to better prepare. Changes made during the Open Enrollment Period will take effect on Jan 1st whereas changes made during the Medicare Advantage Open Enrollment Period will take effect the first of the month after the plan gets your request.
Step 1: Assess whether your current insurance plan is meeting your health needs and/or goals.
If you are in Maryland and are unsure whether your Medicare benefits/options are or need help understanding what they mean, call the State Health Insurance Assistance Program (SHIP) at 410-767-1100. SHIP is an unbiased assistance program that can help you understand and make educated decisions about your Medicare plans.
You can browse through Medicare health and drug plans here.
Step 2: Make a call to Medicare at 800-633-4227 to speak with a representative about enrolling in a Medicare Advantage Plan or Medicare Drug Plan or un-enrolling.
It is important to note that certain Medicare Advantage Plans may not be in network with the provider you are currently seeing. Be sure to check what hospital systems are within the Medicare Advantage Plan’s network and assess what choice is the best choice for you.
Call SHIP at 410-767-1100 if you are in Maryland and looking for unbiased advice.
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