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information you can use during medicare's open enrollment period

This is an important time for people who have Medicare because it gives you the chance to review and make changes to your current Medicare coverage.

This page includes the following articles to help you make sense of Medicare Open Enrollment:

1. What are Some Things to Consider When Shopping for Medicare Coverage?
2. What’s the Difference Between Original Medicare and Medicare Advantage?
3. Should You Consider Buying a Medigap Policy?
4. How the State Health Insurance Assistance Program (SHIP) Can Help You During Medicare Open Enrollment
5. Medicare Savings Program
6. Podcast Episode 25: Medicare 101 - Learn About the Basics of Medicare

what are some things to consider when shopping for medicare?

Take the time to think about what YOU need to have included in a health policy. Just because something is a good choice for a friend doesn't mean it's a good choice for you. 

Things to Consider

• Basically, there are two ways to get your Medicare coverage — Original Medicare and Medicare Advantage (Medicare-approved plans from private companies). There are differences between the two that are important to understand when choosing your coverage.
• If you are looking at a Medicare Advantage plan, check with your healthcare providers (such as your doctor and hospital) to be sure they are in that plan’s network. In other words, you want to be sure that your doctors and other healthcare providers accept that particular insurance. You can quickly find out this information by calling your doctor’s office.  
• If you are choosing a Medicare prescription drug plan, check to see if your prescription medications are included in the plan. You have options such as calling the prescription plan and speaking with a representative or going to their website to look up your prescriptions.
• A low monthly premium may not always be the best overall value to meet your specific needs. Due to the plan’s deductible and other out-of-pocket costs, you may end up paying more in the long run. Review the plan’s estimated total costs so you can avoid negative financial surprises.
• If you take PrEP drugs to prevent HIV, here's an important update from the Centers for Medicare & Medicaid Services (CMS). On August 13, 2024, CMS announced that coverage for PrEP will switch from Medicare Part D to Part B. The final decision is expected in late September 2024, and coverage would begin after that. Information about this coverage transition can be found at: PrEP for HIV & Related Preventive Services.

what's the difference between original medicare and medicare advantage?

When you turn 65, you get the option to enroll in Medicare, which helps pay for your healthcare. You will have two main choices: Original Medicare or Medicare Advantage. Each has its own pros and cons. Therefore, taking time to fully research and know the differences can help you choose the best option for your needs.

What Is Original Medicare?

Original Medicare is the traditional Medicare program run by the government. It’s made up of two parts:

• Part A: This covers hospital stays, nursing home care, and some home health care.
• Part B: This covers doctor visits, outpatient services, and preventive care like vaccines.

With Original Medicare, you can go to any doctor or hospital in the U.S. that accepts Medicare. This gives you a lot of flexibility. However, you still have to pay some costs out of your own pocket, like co-pays, deductibles, and co-insurance (your share of the costs). There’s no yearly limit on how much you might have to pay, so costs can add up.

To help with these extra costs, many people also buy Medigap (Medicare Supplement Insurance) to cover what Original Medicare doesn’t pay. Original Medicare doesn’t cover prescription drugs, so you’d also need to sign up for a separate Part D plan to get drug coverage.

What Is Medicare Advantage?

Medicare Advantage (also called Part C) is a different way to get Medicare benefits. Instead of getting coverage directly from the government, you get it from private insurance companies that work with Medicare. Medicare Advantage plans must cover everything that Original Medicare covers, but they often include extra benefits too.

Many Medicare Advantage plans come with:

• Prescription drug coverage (so you don’t need to sign up for a separate Part D plan).
• Out-of-pocket limit: This limits how much you have to pay in a year for your medical expenses.

The biggest difference is that Medicare Advantage plans usually have networks of doctors and hospitals. This means you might need to see doctors or go to hospitals that are part of the plan’s network, or you’ll pay more. Some plans also require referrals to see specialists.

When choosing between them, think about your healthcare needs, budget, and preferences for flexibility. If you’re still unsure, it might help to talk to a SHIP counselor counselor or use Medicare’s Plan Finder to compare your options.

Read the SHIP article, How the State Health Insurance Assistance Program (SHIP) Can Help You During Medicare Open Enrollment, on this page for more information about how SHIPs can help you during Medicare open enrollment.

should you consider buying a medigap policy?

When it comes to Medicare, you might hear about something called a “Medigap” policy (also called Medicare Supplement Insurance) that is a valuable option to think about. If you’re wondering more about Medigap and whether you need it, this article will explain everything in simple terms.

What Is a Medigap Policy?

A Medigap policy is extra health insurance that you can buy from a private company to help pay for the costs that Original Medicare doesn’t cover, like co-pays, co-insurance, and deductibles. It’s called “Medigap” because it helps fill the “gaps” in your Medicare coverage.

Medigap plans work alongside Original Medicare. Medicare pays its share of your health expenses first, and then your Medigap policy steps in to cover some or all the remaining costs.

What Does a Medigap Policy Cover?

Each Medigap policy offers a different level of coverage, but most plans cover things like:

• Co-pays: These are the small amounts you pay for doctor visits or treatments.
• Deductibles: These are the amounts you must pay before Medicare starts covering your expenses.
• Co-insurance: This is an amount you may be required to pay as your share of the cost for benefits after you pay any deductibles.

Some Medigap plans also cover costs like:

• Emergency care when you’re traveling outside the U.S.
• Excess charges: If a doctor charges more than what Medicare covers, some Medigap policies pay the difference.

What Does Medigap NOT Cover?

While Medigap can help with many out-of-pocket costs, it doesn’t cover everything. For example, Medigap policies do not cover prescription drugs, dental care, vision care, hearing aids, or long-term care like nursing home stays. You’d need other types of insurance for those services.

How Do You Get a Medigap Policy?

To get a Medigap policy, you need to be enrolled in both Medicare Part A and Part B. Then, you can buy a Medigap policy from a private insurance company. These companies offer standardized Medigap plans, which means the benefits of each plan are the same no matter which company sells it.

When Can You Buy Medigap?

The best time to buy a Medigap policy is during the Open Enrollment period. During this time, you can buy any Medigap policy offered in your state.

After this period, if you try to buy a Medigap policy, the insurance company could deny you coverage or charge higher rates based on your health status.

Why Would You Want a Medigap Policy?

A Medigap policy is extra insurance that helps cover the costs that Original Medicare doesn’t pay. While it doesn’t cover everything (like prescription drugs), it can give you peace of mind by reducing your out-of-pocket expenses for healthcare. If you’re enrolled in Original Medicare and worried about high medical costs, Medigap might be the right option for you.

Before buying a policy, compare different Medigap plans to see which one fits your budget and health needs.

how the state health insurance assistance program (ship) can help you during medicare open enrollment

Medicare Open Enrollment is an important time for people who have Medicare. It’s the time when you can make changes to your health or drug plans, and those decisions can affect your healthcare for the next year. But with so many choices, it can get confusing. That’s where the State Health Insurance Assistance Program (SHIP) comes in.

SHIP offers free help to guide you through the process so you can make the best decision.

What Is SHIP?

The State Health Insurance Assistance Program (SHIP) is a free service that provides one-on-one help with Medicare questions and enrollment. Each state has its own SHIP with trained counselors who are familiar with the plans and options available in your area.

SHIP counselors are unbiased, which means they don’t work for insurance companies and won’t try to sell you anything. Their goal is to give you accurate, easy-to-understand information to enable you to make informed choices about your Medicare coverage.

How Can SHIP Help During Open Enrollment?

SHIP counselors can help in many ways during Medicare Open Enrollment:

• Understanding Your Options. Medicare can be confusing. SHIP counselors can explain the different parts of Medicare, such as Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug plans). They’ll help you understand how each plan works so you can decide what’s best for you.
• Comparing Plans. Every year, Medicare plans change. Your current plan might cost more next year or stop covering your medications. SHIP counselors can help you compare different plans based on your health needs and budget. They use tools to show you how much each plan will cost and what’s covered, so you can find the plan that’s right for you.
• Checking Prescription Drug Coverage. If you have a lot of medications, it’s important to find a Part D plan that covers your prescriptions at a good price. SHIP counselors can review your current medications and see which plans will cover them next year. This can save you money on drug costs.
• Helping Low-Income Individuals.If you have a limited income, you might qualify for programs that can lower your Medicare costs. Programs include Extra Help for prescription drugs or Medicaid. SHIP counselors can check to see if you qualify and help you apply for these programs.