Shopping for Medicare coverage is pretty much the same thing as shopping for other health care insurance. The difference is that Medicare plans are tailored to those who are over 65 and those who are disabled.

People who are enrolled in Medicare can make various types of changes to their coverage during the open enrollment period. Understanding a bit about Medicare can help you make decisions during the open enrollment period.

The last thing anyone on Medicare needs to do is to sit back and ignore the fact that it’s time for open enrollment. This is your once-a-year opportunity to ensure the coverage you’re paying for meets your needs and is the most budget-friendly option available.

Senior couple relaxed as they took advantage of the prescription drug plan
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What Is Medicare Advantage?

Medicare Advantage, also called Medicare Part C, is a type of Medicare health plan offered by private insurance companies. It provides an alternative to Original Medicare (Medicare Part A and Medicare Part B) for hospital insurance and medical insurance. Medicare Advantage plans have at least the same benefits as Original Medicare, but these types of plans typically offer more coverage. In addition to hospital and medical costs, many Medicare Advantage plans cover dental, vision, and hearing services. Most Medicare Advantage plans also include prescription drug coverage (Medicare Part D).

Medicare Advantage coverage is offered by Medicare-approved private insurance companies instead of being managed directly by the federal government. However, plans must follow Medicare’s coverage rules. Plans must also provide members with the same protections as Original Medicare. In most cases, Medicare Advantage enrollees will need to use health care providers that participate in the plan’s network and service area. Therefore, a Medicare Advantage plan typically offers a limited selection of physicians and facilities compared with Original Medicare.

Medicare Advantage plans range in cost and coverage levels, which lets you compare plans and select one that meets your specific needs. The availability of plans depends on your geographic location and the health insurance provider. The most common types of Medicare Advantage plans are health maintenance organization (HMO) plans and preferred provider organization (PPO) plans, followed by private fee-for-service (PFFS) plans and special needs plans (SNPs).

People who are eligible for Original Medicare (Medicare Parts A and B) are also eligible to enroll in a Medicare Advantage plan if they’re at least 65 years old or have a qualifying disability. Enrollees must also:

  • Live in an area where Medicare Advantage plans are sold
  • Be a U.S. citizen or permanent resident
  • Not have end-stage renal disease — although SNPs may still be an option
  • Not be enrolled in Medigap insurance

When Is the Medicare Advantage Open Enrollment Period?

The open enrollment period for a Medicare Advantage plan is October 15 through December 7 each year. It’s important to note that this period is specifically for people who are already enrolled in Medicare. When you become eligible, you can sign up for Parts A and B during the initial enrollment period, or you can do this during general enrollment at the beginning of each year. Some people are also eligible for a special enrollment period if certain life events happen.

The changes you make to your Medicare coverage during the open enrollment period from October 15 through December 7 of each year will become effective on January 1. You don’t have to make any changes to your plan if it still meets your needs.

If you don’t make any changes, you’ll have to keep the coverage you currently have. You likely won’t be able to change again until the open enrollment period the following year. People who haven’t fully checked out their coverage options and found the best option for their needs might quickly realize that not changing to another plan is very costly.

What Can You Change During Open Enrollment for Medicare Advantage Plans?

There are several changes you can make during the open enrollment period. Be sure to consider your current medical conditions and Medicare needs so you can compare them to the available plans. Remember, this is a time when you can change Part C and Part D of your coverage.

  • You can drop Part C and Part D coverage to return to only the original Medicare that encompasses Part A and Part B.
  • You can add or drop a Part D plan from your Medicare coverage.
  • You can change from Original Medicare to Medicare Advantage.
  • You can switch to a new Part D option.

What Should You Evaluate When Reviewing Your Options?

There are several things you need to consider when you’re reviewing your options during the open enrollment period. You must think about the type of care you’re going to need during the upcoming year. It’s imperative that you choose the options that most closely reflect the coverage you’ll need during that period. This can help you save money and get the medical care you need.

When you’re reviewing Part D plans, be sure you look into the formulary to determine if the drugs you take are covered. This is one factor that can greatly impact your out-of-pocket expenses, because the formulary can vary greatly from one plan to another. You should check the monthly premiums, cost of the drugs you take and any deductibles you’ll have to pay. You also need to determine whether the pharmacy you use is in the network for a plan.

Additionally, you’ll need to determine whether the doctors you see are in the network for the plan you’re considering. Even if they were in the plan for the past year, ensure they’re still in the plan as these plans often change. You should have been alerted to the changes in writing, but there’s a chance you might not have gotten the information.

Another thing for you to consider is the quality of the plan. If you’re in a lower-quality plan now, you might be able to upgrade to a higher-quality plan that better meets your needs. The higher-quality plans might come with a higher premium, but doing the math might show you’re going to pay less out of pocket during the upcoming coverage year than you are now.

What Else Should You Consider?

Many Medicare Advantage plans also include supplemental services for things like vision and hearing services. Dental may also be covered. Check out the costs, including the deductible on these. You should also verify that the services you’re likely to need will be covered by the plan you’re considering.

Some plans have other services you might enjoy, such as health club memberships. Even if you don’t plan on doing major workouts, you might be able to take yoga classes or walk on the treadmill. This might encourage you to stay active, which can further improve your health. Just remember to discuss your wishes with your doctor to ensure you’re choosing activities that are safe for you.

Contact Us for Help Regarding the Open Enrollment Period

Senior couple enjoying sunset after setting up their prescription drug coverage

Navigating through the options you have during open enrollment can be challenging.

Give Medicare Planning of America a call at 888-225-1609 so we can answer your questions about your Medicare coverage and the open enrollment period. We’re here to help!