It’s Fall: Time to Evaluate Your Medicare

Written by Ana Perez-Arrieta

Posted on Oct 31, 2018

It’s not just the season for goblins and pumpkin spice.  It’s also the season for Medicare enrollment, and that’s why there has been a flurry of fliers in the mail and with your daily newspaper (if you still get one).

This year, the annual enrollment period started October 15 and continues until December 7.  What does that mean?  Well, if you are 65 or older and already on Medicare, you can make changes to various aspects of your coverage.  Such as:

• Switch from Original Medicare to Medicare Advantage, or vice versa (more on the difference below).
• Switch from one Medicare Advantage plan to another.
• Switch from one Medicare Part D (prescription drug) plan to another.
• Add Medicare Part D if you didn’t get it when you were first eligible (though there may be a late enrollment penalty).
• If you already like your plan, you don’t have to do anything.  But it’s a good time to evaluate your options because your premiums might be going up and insurers’ offerings may have changed.  In late September, most Medicare beneficiaries should have received an Annual Notice of Change and Evidence of Coverage statements from their Medicare Advantage and Medicare Part D providers explaining any changes.  You may want to find those documents and consider changing.

Confused?  Consider attending a free informational session at Pima Council on Aging (PCOA; www.pcoa.org).  Remaining sessions will be held:

• Nov. 3 from 1:30-4:40 p.m. at the Oro Valley Public Library, 1305 W. Naranja Drive.
• Nov. 6 from 2-5 p.m. at the Murphy-Wilmot Library, 530 N. Wilmot Road.
• Nov. 9 from 1-4 p.m. at the Mission Public Library, 3770 S. Mission Road.
• Dec. 4. from 2-5 p.m. at the Murphy-Wilmot Library.
• You also can get one-on-one assistance at PCOA’s Medicare line (520-546-2011).

Now that we have the seasonal hoopla out of the way, let’s back up to the basics.  Medicare, you probably know, is the government’s health insurance program for Americans who are 65 or older.  It also covers people who are younger than 65 with certain disabilities.  Medicare has four basic parts:

Part A includes hospital insurance, which helps pay for inpatient care in a hospital or skilled nursing facility following a hospital stay. It also pays for some home health services and hospice care.

Part B includes medical insurance, which helps pay for medically necessary doctors’ visits, outpatient care, lab work, home health care, durable medical equipment, and some preventive services.

Part C includes Medicare Advantage Plans, which are managed care plans provided through private insurers, and those plans cover all the benefits provided under Parts A and B. As an alternative to Part C, you could shop around and purchase “Medigap” or “Medicare Supplemental” insurance to get many of the same benefits as a Medicare Advantage Plan.  These Medigap/Medicare Supplemental plans help cover Medicare’s co-payments and deductibles.  The Medicare Advantage Plans limit the health providers that you may use, but they are typically cheaper than the combination of regular Medicare (Parts A and B), plus private Medigap supplemental insurance.

Part D, as we alluded to above, provides prescription drug coverage, which helps pay for the cost of prescription drugs.

If you (or someone you know) is about to turn 65, it’s a good idea to get started as many as six months before that significant birthday, if possible.  The “initial enrollment period” generally starts three months before a person turns 65 and ends three months after.

If you are already receiving Social Security, then your enrollment in Parts A and B will be automatic; everyone else must sign up.  If you sign up a few months before you turn 65, then you can ensure coverage will start on the first day of the month of your 65th birthday.

Be sure to enroll on time, otherwise you will have delays in coverage, and penalties will be assessed.  For example, if you fail to enroll for Part A and/or Part B of Medicare during the initial enrollment period, then you must wait until the general enrollment period for Parts A and B, which begins on January 1 and ends on March 31 of each year.  Coverage then begins July 1.  You may have to pay higher premiums if you miss the initial enrollment period.

Note that if, at 65, you are still working at a job that provides health benefits or have coverage through a spouse’s group plan, you might want to delay enrolling in Part B, but you generally still want to enroll in Part A.  Be sure to talk with the human resources specialist at your employer or your spouse’s employer to select the right choice for you.

After you sign up for Part B, you have six months to enroll in a Medigap policy; after that, you can be denied or charged more because of your health.

Note that the fall isn’t the only time you can make changes.  Between January 1 and March 31, if you are enrolled in a Medicare Advantage plan, you can switch to another Medicare Advantage plan or leave and return to Original Medicare and buy a Part D prescription drug plan to supplement it.

Another good resource: the Social Security Administration’s website (www.ssa.gov).