Medicare Open Enrollment: How to Shop


There are two open enrollment periods for Medicare that offer the chance to change your coverage. Here are some ways to compare plans.

Medicare plans offer an annual open enrollment period, as with all health plans. Current Medicare beneficiaries have the opportunity to review their coverage and make possible changes.

Medicare only has one open enrollment window each year, which runs from Oct. 15 through Dec. 7. There is also an annual Medicare Advantage open enrollment window that runs from January 1 through March 31.

What is Medicare open enrollment?

Open enrollment is the health care user’s chance to evaluate the plan they have, take a look at what’s on the market and update their coverage for the coming year. Open enrollment is for consumers who already have Original Medicare or Medicare Advantage.

Any changes made during the main open enrollment period (October 15 through December 7, 2008) will be effective on January 1. Any changes made during the Medicare Advantage open enrollment period will be effective on January 1.

ALSO READ  Best cheap homeowners insurance in Wilmington

What you can do to change it

During open enrollment, you have the ability to change many things. These are the things you can do between Oct. 15 and Dec. 7.

  • Change from Original Medicare to Medicare Advantage.
  • Change from a Medicare Advantage Plan to Original Medicare.
  • You can move from one Medicare Advantage plan to another.
  • Join a Medicare prescription drug plan.
  • Change from one Medicare prescription drug program to another
  • Drop your Medicare prescription drug coverage

You can open Medicare Advantage open enrollment from January 1 through March 31.

  • You can switch from one Medicare Advantage plan to another.
  • You can quit your Medicare Advantage Plan to go back to Original Medicare.

It is possible to switch to a Medicare Advantage plan and return to Original Medicare, but it is not possible to do so between Oct. 15 and Dec. 7.

Comparison of Original Medicare and Medicare Advantage

Open enrollment is a time to switch to a Medicare Advantage plan if you are enrolled in Original Medicare Part A or Part B. Some people find purchasing a Medicare Advantage plan easier than others.

ALSO READ  Protect Your Restaurant Business With The Right Insurance

Deborah Gordon, author of The Health Care Consumer’s Manifesto, How to Get the Best for Your Money, says that some people like the idea of a single-stop shop.

Here are some things you need to know:

  • Medicare Advantage Plans provide all the benefits of Part A, Part B. An Advantage plan will not provide less coverage.
  • Prescription drug coverage is available in most Medicare Advantage Plans. For prescription drug coverage, you will need to sign up for Medicare Part D if you aren’t a member of Original Medicare.
  • Medicare Advantage Plans often cover things not covered under Original Medicare. These include vision, hearing, and wellness programs.
  • A Medicare Advantage Plan requires that you only use the network of health care providers. Referrals may be required to see specialists. Original Medicare allows you to use any American health care provider that accepts Medicare. Referrals are not usually required.
  • Original Medicare may have lower out-of pocket costs for Medicare Advantage plans. Original Medicare users may have to purchase supplemental coverage to help cover out-of-pocket costs.
  • Original Medicare does not limit your annual out-of-pocket expenses. A Medicare Advantage Plan covers 100% of your costs for the remainder of the year, provided you have spent a certain amount.
  • If you are traveling outside the United States, neither plan will cover you. However, Original Medicare may allow you to buy a supplemental policy which would cover you in foreign countries. You can’t buy supplemental coverage under Medicare Advantage.
ALSO READ  Commercial Roadside Service for Your Small Business

How to Compare Medicare Advantage Plans

Because there are so many options, choosing a Medicare Advantage plan can seem daunting. Gordon states that the average Medicare beneficiary has about two dozen options. Although it sounds great, Gordon says, “It can be overwhelming for consumers to have that many choices.”

There are five types of Medicare Advantage Plans.

  • HMO (Health Maintenance Organization) plans: If you are in an emergency, this type of plan will require that you see an in-network provider. Many require that you get a referral in order to see a specialist.
  • Preferred Provider Organization (or PPO) plans: This type of plan allows you both to see in-network and outside-network providers. However, it is typically more costly to travel out of network.
  • Private Fee-for Service, also known as PFFS plans, allows you to see any Medicare-approved doctor as long as they agree to accept your plan’s payment terms. You may also be able to access a network of providers. Although you can still see doctors who don’t accept the payment terms of the plan, you may pay more.
  • SNPs, or Special Needs Plans: This type of plan offers benefits for people who have certain diseases or need to receive health care such as nursing home or cancer. This plan also benefits those with limited incomes.
  • The Medical Savings Account (or MSA) plans combine a high-deductible plan with a savings account that can be used to pay for medical costs.
ALSO READ  Important Coverage Features of Lawyers' Malpractice Insurance

You will need to consider your needs and compare the benefits of each plan when choosing between Medicare Advantage Plans. You will want to have health coverage that your doctor accepts if you have a chronic condition. Prescription drugs may be covered by some plans, which can result in lower out of pocket costs.

These are some questions you can ask:

  • Is it necessary to obtain a referral? Certain plans will require that you get a referral form your primary care doctor before you can see a specialist. You can choose a plan that allows you more flexibility if this is not what you prefer.
  • What are their benefits? Are you looking for vision and dental coverage? You should look for the plan that provides you with the benefits you need.
  • What is the cost of your medications? Compare the costs of prescription drugs to see if you are paying the same amount.
  • Are your doctors covered? Find out if your doctors are included in the networks for the plans you’re looking at.
  • How do they rate? Each Medicare Advantage Plan comes with a star rating that ranges from one star to five stars. Gordon said that he spoke to a Massachusetts consumer who would not consider any plan below a 4-star plan.
ALSO READ  Garagekeepers Legal Liability vs Primary Liability insurance

How to change Medicare Advantage Plans

You can switch to another Medicare Advantage plan if you are already enrolled in one of the open enrollment periods: Oct. 15-Dec. 7, Jan. 1-March 31. Once you sign up for a new plan you will be automatically removed from your existing plan.