You can prepare for the Annual Enrollment Period by reviewing your Medicare coverage needs, comparing available plan options, and brushing up on the basics.
The Annual Enrollment Period
The Annual Enrollment Period, also known as the Open Enrollment Period, comes every year from October 15 to December 7. This gives Medicare beneficiaries the chance to enroll in a new yearly contract for coverage beginning January 1. Medicare Advantage plans and Medicare Part D prescription drug plans are up for re-enrollment each fall during this time.
If you have a Medicare Advantage plan, you have the chance to sign a new contract with the same plan, switch to a different Medicare Advantage plan, or drop your plan and return to Original Medicare. If you have a Medicare Part D plan, you have the same options and can choose to renew your current plan, find a different prescription drug plan, or drop your plan.
To prepare for the Annual Enrollment Period, you should understand your coverage options, decide what coverage you need, find what coverage is available and compare prices. For extra preparation, overviews of what to expect and for the answers to all of your questions, look over the “Medicare & You” handbook produced by Medicare or direct your questions to a Medicare expert with Healthcare Solutions Direct.
Know Your Coverage Options
Understanding the different parts of Medicare and the coverage offered by each of the plan types is crucial for any person getting ready to sign up for a new plan during the Annual Enrollment Period. For starters, here are the basics about the different parts of Medicare:
Medicare Part A is hospital insurance. It covers inpatient care in a hospital or skilled nursing facility, along with hospice care and home health care. Medicare Part B is medical insurance, covering preventive and medically necessary care. This can cover clinical research, ambulance services, durable medical equipment (DME), mental health care, and limited outpatient prescription drugs. Together, Medicare Part A and Part B make up Original Medicare, which is what you first sign up for during your Initial Enrollment Period. You remain enrolled in Original Medicare as long as you continue to pay your premiums, which you still need to pay even if you sign up for a Medicare Advantage plan.
Medicare Part C is Medicare Advantage. These plans are an alternative to Original Medicare and offer the same benefits as under Part A and Part B coverage. Medicare Advantage plans can also offer their members additional packages for dental, hearing, and vision care, prescription drug coverage, and more. Often, these plans work with networks of providers, which can influence the costs of seeing different medical professionals.
Medicare Part D is prescription drug coverage. Part D plans have standardized coverage to cover the most commonly prescribed categories of drugs. Once you have paid the plan deductible, you are charged only small copayments for each prescription drug. Costs vary based on whether a drug is generic or brand-name, preferred or not preferred, or specialty.
Decide What Coverage You Need
Once you understand what your coverage options are, you need to take stock of your healthcare needs. The more extensive your healthcare needs, the more expensive your expenses will be. If you know you are someone who has a chronic illness, condition, disability, or other health matter that requires frequent or costly medical appointments, you will want to look for cost savings.
Medicare Advantage plans have out-of-pocket maximums, which differentiates them from Original Medicare. These limits cap your expenses toward copayments, coinsurance, and deductibles at a set amount, helping you avoid medical debt. People with significant anticipated medical expenses should consider comparing Medicare Advantage plans in their area, especially if they are not enrolled in a Medicare Supplement plan (you can only be enrolled in one or the other).
If you regularly take medications, you will want prescription drug coverage. You will be able to find coverage through a Medicare Advantage Prescription Drug (MAPD) plan or a Medicare Part D plan. The prescription drug coverage between these options is equivalent and creditable. If you intend to sign up for a prescription drug plan, do so as soon as you are able, to avoid paying late enrollment fees for having a lapse in creditable drug coverage.
Find Out What Coverage Is Available
When looking for Medicare Advantage plans and Medicare Part D prescription drug plans, know that you can only sign up for plans if you are enrolled in Medicare Part A and Part B and live within the plan’s service area. You can use Medicare’s online tools to find and compare plans in your region.
It is important to view the formulary of each Part D plan or MAPD plan you are considering. This lists the drugs that each plan covers, and will tell you if your prescriptions will be covered or not. Find a plan that covers the prescriptions you are currently taking, and for a reasonable price.
One of the major draws to signing up for Medicare Advantage and Medicare Part D plans is the potential for cost savings. You will need to review the costs of each plan in your area that offers the coverage you are looking for. Expect each plan to have costs for monthly premiums, yearly deductibles, copayments, and coinsurance.
The deductible is an important number to consider. The higher the deductible, the lower your premiums are likely to be. At the same time, a higher deductible means that you would be responsible for more money before your insurance began to pay its share toward your covered healthcare expenses.
Review the ‘Medicare & You’ Handbook
Medicare has a helpful guide to walk you through the parts of Medicare, called the “Medicare & You” handbook. It is updated every year with new things you should know about Medicare coverage and policies. It also allows you to search for whether or not Medicare covers your test, item, or service, which makes it a handy resource for later. Additionally, it guides you to cost-saving programs and state resources that can help you find the information you need.
There are a lot of things you can do to prepare for the Annual Enrollment Period. Learning about Medicare coverage and costs and finding out about the coverage and costs of plans in your area will help you be ready to make decisions in the fall.
Do you have additional questions about preparing to review your coverage, comparing plans, or knowing how to find the right Medicare coverage? Let us know what you need. Schedule an appointment with one of our Medicare experts today.