Understanding Medicare and Kicking Off Open Enrollment

Chances are if you’re turning 65 you received your 2015 Medicare and You Handbook in the mail. It is in the pile with the AARP subscription and maybe a few other new offers coming your way. Take heart. While it may seem extremely complicated, part of being a good healthcare consumer is understanding your choices and the window of opportunity you have to make them. We’re kicking off Open Enrollment that begins October 15th.  by sharing a Medicare overview and some important insights and tips from a recent Illuminage webinar given by Brandy Bauer from the National Council on Aging. 

Understanding the Parts of Medicare

  • Part A: (Hospital Insurance) This part covers inpatient hospital care, hospice care, some limited skilled nursing.
  • Part B: This part covers outpatient items such as physician checkups, shots, medical equipment, some preventative care, and ambulance usage and some home health care. 
  • Part A+ Part B is referred to as “Original Medicare”
  • Part C: This is known as “Medicare Advantage”. It refers to Medicare coverage offered via a private Medicare health plan. This includes all the benefits and services covered under Part A and Part B. *Note: This is offered by Medicare-approved private insurance companies.   
  • Part D: This part is for prescription drug coverage. Different coverage is offered for different deductibles. This is also run by Medicare-approved private insurance companies. 
  • Medigap- Private supplemental Medicare coverage to help with costs not covered by your original Medicare. People turning 65 and enrolled in Part A & B have a 6-month window to enroll in Medigap. The enrollment period is the 1st month you’re 65 and enrolled in Part B. If you are 65 and still actively employed, you have a 63 day period to enroll when your employee insurance coverage ends.   

Do I Have to Enroll and When?

Yes, while you may get the booklet and social security packet automatically in the mail, you are not automatically enrolled in Medicare. There are some decisions to make regarding what options best fit your needs. If you are enrolling in Medicare for the first time, the Initial Enrollment Period is a 7 month window around your 65th birthday, meaning, you have 3 months prior to your birthday and 3 months following your birthday to enroll. There are steep penalties for enrolling outside this window. For example, in Part B, you will be charged 10% more for every 12-month period you could have enrolled but didn’t. For Part D, you will pay an average of 1% more for every month you are late enrolling. While it may not seem like much it will compound over your lifetime. 

There are a few exceptions to this. Individuals may automatically be enrolled for some Medicare if:

  • They receive social security disability (SSDI). After 24 months on SSDI, you are enrolled in Medicare.
  • Those with ALS get Medicare coverage as soon as they receive SSDI
  • People turning 65 who are already on Social Security.

Everyone else must enroll.

How to Enroll 

You will apply for Medicare through the Social Security office. You should receive a packet in the mail automatically around your birthday. Remember, you are not automatically enrolled in Medicare. To enroll visit socialsecurity.gov/medicare.

Open Enrollment: Can I Make Changes to My Choices?

The Open Enrollment Period occurs each year from October 15th- December 7th. This is an important time to proactively assess your coverage and makes changes without penalty. Plans change and so do you. The plan you had in your 60s may not meet your needs in your 70s. Changes in condition or other circumstances may mean that another plan or configuration of benefits may better fit your needs in the coming year. During open enrollment those with Medicare Part A and B can:

  • Change original Medicare to Medicare Advantage
  • Leave Medicare Advantage or return to Original Medicare
  • Join, drop, or change Part D
  • Switch Medicare Advantage plans

The new coverage takes effect on January 1st.

For the four C’s you can use to evaluate your plan click here.  

Special Enrollment Periods

There are a few events that allow for special enrollment periods. These include:

  • Loss of active employee coverage
  • A move out of a coverage area
  • Entering or leaving an institution
  • Qualifying for Part D low income subsidy

Medicare Disenrollment Period

For those that are wishing to leave Medicare Part C to return to Original Medicare or those wanting to pick up Part D, there is a Medicare Disenrollment Period. This runs January 1-February 14th each year. You cannot switch Medicare Advantage plans, Part D plans, or move Original Medicare to Medicare Advantage during this window.

How Does Medicare Impact My Insurance I got from the Marketplace?

The insurance market places do not affect Medicare coverage. Original Medicare, Part D, Medigap, and Medicare Advantage, are all NOT on the marketplace. In fact, you are not allowed to have both Medicare and marketplace insurance. It is illegal for an insurer to offer you insurance if they know you have Medicare. Your marketplace plan may seem much more cost effective than Medicare, but it is important to remember that those are subsidized plans. When you are eligible for Medicare at age 65, you lose all subsidies for your marketplace insurance plan causing your once appealing price and premiums to rise significantly.

Further Resources

We encourage you to do your research and get advice from reputable sources. Here are a few websites to help you navigate Medicare and be an informed healthcare consumer.

Medicare.gov | 1.800.Medicare
Use their plan finder to help you compare plans by type and find out estimated costs, coverage, and benefits found in each plan at www.Medicare.gov/find-a-plan.  

Find plans that work for you and search to see if you tests, drugs, or other items are covered. Find answers on enrollment and other aspects of Medicare all along the way.

Medicare Rights Center
Click or call to get the answers you need to make the right decisions for your Medicare.
800.333.4114 | Medicareinteractive.org

Online screening program to help you take advantage of all the benefits you’re eligible for.

For more open enrollment tips from the National Council on Aging visit: http://www.ncoa.org/enhance-economic-security/center-for-benefits/highlights-news/medicare-open-enrollment-tips-consumers.html

Fact sheets on Medicare, open enrollment periods, etc.

My Medicare Matters: an education resource from the National Council on Aging regarding Medicare. https://www.mymedicarematters.org/

Key Enrollment Periods Calendar from NCOA http://www.ncoa.org/enhance-economic-security/center-for-benefits/mmm-counselors-corner/enrollment-periods-calendar.html

Published on October 15, 2014.