Medicare Open Enrollment – Part 1

As you probably know, Medicare is the federal healthcare program for Americans age 65 and older (with some beneficiaries qualifying earlier through disability or medical conditions.) If you are already receiving Social Security benefits, you may be enrolled in Medicare automatically. But for most people the initial enrollment period for Medicare coverage is a seven-month window that includes the month a person turns 65 and the three months before and after that month.

Medicare is made up of four parts:

Part A (Hospital Insurance). This provides coverage (with various defined limits) for inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Part B (Medical Insurance). This is coverage for doctors’ services, outpatient care, medical supplies, and preventive services.

Part C (Medicare Advantage). This is a Medicare health plan offered by private companies as an alternative to direct participation in Medicare. The insurer contracts with the Medicare program to provide all Part A and Part B benefits to those signing up for one of its Medicare Advantage plans.

Part D (Prescription Drug Coverage). Part D is a program that helps cover the cost of prescription drugs for people with Medicare. It is provided through private insurance companies approved by Medicare.

In thinking about how Medicare affects you or a loved one, keep two things in mind:

First, although Medicare offers significant financial help to seniors in covering their healthcare costs, it is not free. There are premiums, deductibles, and co-pays that apply. So, selecting carefully from among the various coverage options available can be important both for optimizing the coverage you get and minimizing the costs you’ll be responsible for.

Second, Medicare is not a “one size fits all” program. The complexity of Medicare’s alternatives places a responsibility on each participant to make informed choices about the options available in the person’s particular situation.

Medicare questions and options can seem daunting, but the good news is you’re not alone. More than 65 million Americans are enrolled in Medicare–a little more than half in original Medicare (Parts A and B) and the remainder in a Part C Medicare Advantage plan. Everyone faces the same set of questions: what options make sense for me? And what changes, if any, should I make during this year’s open enrollment period? Here are two recommended free resources that can help as you review your options:

• Medicare’s website, https://www.medicare.gov/, offers detailed information in different languages. It’s flagship guide, Medicare & You, is available to download and is also mailed to each Medicare household every year in late September.
• Every state offers its’ SHIP (State Health Insurance Assistance) Program. This is a national program that offers free, confidential, and unbiased counseling and assistance to Medicare beneficiaries and their families. SHIP counselors are trained to help individuals understand their Medicare options, compare plans, and resolve issues related to Medicare coverage. You can find contact information for your state’s SHIP program at www.shiphelp.org, or call the national SHIP helpline at 1-877-839-2675.

Watch for our next post in this series, MEDICARE OPEN ENROLLMENT – PART II.