Medicare Open Enrollment: What You Need to Know
Medicare Open Enrollment takes place every year from October 15 through December 7. It is your chance to review your Medicare health and drug coverage and make changes if you want to. Any changes you make begin January 1.
During Open Enrollment, you can:
- Switch from one Medicare Advantage plan to another.
- Switch from Original Medicare to Medicare Advantage, or from Medicare Advantage to Original Medicare.
- Join, drop, or switch a Medicare Part D drug plan.
Even if you're happy with your current coverage, it is a good idea to check what may change next year. Your prescription drug coverage, costs, pharmacy choices, or Medicare Advantage plan network could be different.
What should you review?
Our October newsletter walks you through Open Enrollment based on the type of Medicare coverage you have. It includes simple questions to help you review your medicines, doctors, pharmacies, costs, and the things that matter most to you.
Read the October issue of On the Healthcare Front.
What's the Difference Between Original Medicare and Medicare Advantage?
If you have Medicare, there are two main ways to get your coverage: Original Medicare and Medicare Advantage. Both provide Medicare coverage, but they work differently. Understanding the differences can help you decide which option may work best for you.
Original Medicare
Original Medicare is provided through the federal government. It includes:
- Part A (Hospital Insurance), which helps cover inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
- Part B (Medical Insurance), which helps cover doctor visits, outpatient care, durable medical equipment, and many preventive services.
Original Medicare does not include prescription drug coverage. If you want Medicare drug coverage, you can buy a separate Part D drug plan.
With Original Medicare, you can generally see any doctor or use any hospital in the United States that takes Medicare.
You can also choose to buy Medicare Supplement Insurance, also called Medigap. Medigap may help pay some costs that Original Medicare does not cover. It is important to know that Medigap has its own enrollment rules. The October 15 through December 7 Medicare Open Enrollment period is not a yearly Medigap Open Enrollment period.
Medicare Advantage
Medicare Advantage, also called Medicare Part C, is another way to get your Medicare coverage. These plans are offered by private insurance companies approved by Medicare.
Medicare Advantage plans include your Part A and Part B coverage. Most also include prescription drug coverage. Some plans offer extra benefits that Original Medicare doesn't cover, such as vision, hearing, or dental services.
Medicare Advantage plans often use networks of doctors, hospitals, and other healthcare professionals. For non-emergency care, you may need to use people and places in the plan's network. Your plan may also require approval before it covers certain services.
If you are considering a Medicare Advantage plan, check whether the doctors, specialists, hospitals, and pharmacies you use are part of the plan.
Which option is right for you?
There is no single Medicare choice that works for everyone. Start by thinking about what matters most to you:
- Are there doctors or specialists you want to continue seeing?
- Do you travel frequently or spend part of the year in another state?
- Which prescription medicines do you take?
- What will you pay for your coverage and care?
- Are there extra benefits that would be helpful to you?
With Original Medicare, you can generally see any doctor or use any hospital that takes Medicare anywhere in the United States. Medicare Advantage plans may have networks and service areas for non-emergency care, so check how a plan works when you are away from home.
Need Help Understanding Your Medicare Open Enrollment Options? SHIP Can Help.
Comparing Medicare plans can feel like a lot. You may be wondering whether your medicines will still be covered next year, how much you will pay, or which plan includes your doctors and pharmacy. You may simply want someone to explain your choices in plain language.
That is where your State Health Insurance Assistance Program (SHIP) can help.
SHIP offers free, one-on-one Medicare counseling. Each state has a SHIP with trained counselors who can answer your Medicare questions and help you understand your options.
SHIP counselors do not sell Medicare plans and do not work for insurance companies. Their job is to give you unbiased information so you can make the best decision for you.
How can SHIP help?
During Medicare Open Enrollment, a SHIP counselor can help you:
- Compare your options, including Original Medicare, Medicare Advantage, and Part D drug plans.
- Review your prescription drug coverage. Bring a list of the medicines you take so you can see how different plans cover them.
- Understand costs and compare what you may pay with different plans.
You do not have to wait until you've figured everything out before you contact SHIP. That is what they’re there for.
What is Medicare Supplement Insurance (Medigap)?
If you have Original Medicare—or you're thinking about switching from a Medicare Advantage plan to Original Medicare—you may have heard about Medicare Supplement Insurance, also called Medigap.
How does Medigap work?
Original Medicare covers many health care services, but it does not cover every cost. You may still have deductibles, copayments, and coinsurance to pay. Original Medicare also does not have a yearly limit on what you could pay out of pocket for covered Part A and Part B services. That means there is no set dollar amount where Original Medicare starts paying all your covered costs for the rest of the year.
That is why some people choose Medigap, which is extra insurance you can buy from a private insurance company. It works with Original Medicare to help pay some of the healthcare costs you would otherwise have to pay yourself. How much it helps depends on the policy you choose.
Medigap is not the same as Medicare Advantage. Medicare Advantage is another way to get your Medicare coverage. Medigap is extra insurance that works with Original Medicare.
Medigap policies sold today do not include prescription drug coverage. If you want Medicare drug coverage, you can join a separate Part D drug plan.
You pay a separate monthly premium for Medigap. Policies can differ in what they cover and what they cost.
Want to learn more?
If you are thinking about Medigap, there is more to consider, including when you can buy a policy and what options are available where you live.
You pay a separate monthly premium for Medigap, and policies can differ in what they cover and what they cost.