Open Enrollment Guide

For a few weeks every year, there is a period of time where the government allows people who receive health insurance to buy new insurance or make changes to existing benefits. This is known as open enrollment. The main two periods of open enrollment are for Medicare and the federal health insurance Marketplace. For Medicare, open enrollment runs from October 15 to December 7. Whether you’re just looking to enroll in Medicare or you’re already in the program, open enrollment is crucial to making sure that you receive the best coverage at the fairest rate. 

What Is Medicare? 

Medicare is a federally run health insurance program. Usually, anyone over the age of 65 who has paid Medicare taxes for 10 years is eligible, as well as people with disabilities. Unlike Medicaid, Medicare is open to people at any income level. For more information about determining eligibility, the Medicare site itself has a convenient quiz: https://www.medicare.gov/eligibilitypremiumcalc 

The Medicare program is split into four parts:

1. Part A: Covers inpatient care in hospitals, nursing facilities, hospices, and in-home care.
2. Part B: Covers outpatient care, doctor’s visits, durable medical equipment such as wheelchairs, and preventative care.
3. Part C: Known as Medicare Advantage, this is a plan offered by private companies that covers Part A and Part B, and usually Part D as well. Some plans may have additional benefits.
4. Part D: Covers prescription drugs. In order to get part D, one must add a drug plan to Original Medicare or otherwise join a Medicare Advantage Plan that carries drug coverage.
5. Medigap: This is not a part of Medicare itself, but some private insurance companies offer extra insurance plans that help pay for Original Medicare costs. 

From here, Medicare is split into two programs that you can sign up for to receive coverage. During open enrollment, you can also switch between the two options or choose different plans. 

1. Original Medicare: Original Medicare covers Part A and Part B. To receive additional coverage, you can join a separate Medicare plan that covers Part D and to help cover costs. You can also join a Medigap program from a private company.
2. Medicare Advantage: Medicare Advantage covers Part A, Part B, and Part D, as well as extra benefits like vision, hearing, and dental services. This will often require you to use in-network providers but can sometimes have lower costs than Original Medicare.

How to Enroll

First, compare the prices. Comparing Medicare plans is complicated but can save a lot of money. Even if you’re already registered under a Medicare plan, your costs may vary every year. If you’re already enrolled in Medicare, check your mail: your provider should have sent an Annual Notice of Change (ANOC) letter detailing any changes to your plans in the upcoming year. Besides that, anyone thinking of enrolling in a Medicare plan in the upcoming year should also consider the different costs of premiums, deductibles and copays, and prescription drug costs. A helpful resource to determine costs can be found at this link: https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/what-does-medicare-cost 

Also, consider which providers, like doctors, hospitals, specialists, and pharmacies, are in the plan’s provider network. Costs are generally lower in-network, so making sure that as many of the health services a senior needs are covered will save the most money. If the provider that you currently use has been excluded from the network for the upcoming year, it may be necessary to consider a different plan or carrier. On the other hand, if the majority of the providers that you currently use are simply under another plan’s network, it might be a good idea to stay with the same carrier and change to a slightly different plan. 

Finally, if you’ve decided to enroll or change their plan, contacting a local Agency on Aging or browsing on the Medicare Plan Finder website will help give you many options for next steps. If you decide to enroll in Medicare Advantage and are dissatisfied with their plan afterward, you can also change it during the Medicare Advantage Open Enrollment Period, from January 1 to March 31. 

Taking advantage of Open Enrollment to pick the best plan helps keep care costs low and the quality of care high. The world of health insurance is a complicated maze to navigate, but sitting down and comparing plans early will save a lot of time and money later on.