Medicare Open Enrollment for 2016 is Just Around the Corner 

 In Affordable Care Act, Health Insurance, Medicare

Mark your Calendar for These Important Medicare Enrollment Dates

We know open enrollment is confusing and overwhelming.  We are bombarded by information (and some misinformation) about health insurance plans, especially at this time of year when Open Enrollment for Medicare and for the Affordable Care Act Marketplace are right around the corner.

It seems hard to believe, but according to USA Today, a survey by Aflac in 2014 showed that 41% of people spent far less time researching available health insurance plan options (15 minutes or less) compared to the amount of time they spent researching what type of new car (10 hours),  computer (4 hours) or TV (2 hours) to buy.

Medicare health and drug plans can change each year and that’s why it’s important to review and really understand what these changes mean for you – for both your medical health and your financial well-being.  You need to consider not only what you’ll pay in monthly premiums, but also consider out-of-pocket maximum costs, deductibles, copayments and which doctors, hospitals, and pharmacies will actually be in your “network”.  The price of not understanding can be devastating.  And since penalties may apply if you miss certain deadlines, here are some dates to keep in mind when enrolling in Medicare.

(To make the most sense of the following information, you may find it helpful to first review what I call the “Alphabet Soup of Medicare” – Parts A, B, C and D which I have included at the end of this post).

Or jump over to our 2017 complete guide to Medicare.

September & October—Review & Compare

Because your plan can change, it’s important to review any notices that your insurance company sends you.  Look for documents called “Evidence of Coverage” (EOC) or “Annual Notice of Change” (ANOC). If you need help figuring out if the plan will still meet your needs for the upcoming year, there are organizations you can reach out to for free advice like Medicare and Medicaid Assistance Programs (MMAP) or State Health Insurance Assistance Programs (SHIPs).  More resources are listed below.

October 15- December 7:  Open Enrollment

During this period of time, anyone with Medicare can make changes to their health and/or prescription drug plan(s) for the following year.  While there are other times of the year that some policies can be changed (depending on special circumstances such as moving to an area that your current plan no longer covers or no longer being covered by an employer offered plan), Open Enrollment is a time when everyone should review their coverage.  Applications to enroll in a new or different plan must be received by December 7 for coverage to begin January 1.

January 1: Coverage Begins

Provided your enrollment application was received by December 7, your new coverage (or any changes to your benefits or costs if you stayed with the same plan) will begin on January 1.

January 1 – February 14: Medicare Advantage Disenrollment Period

Certain types of Medicare plans called “Medicare Advantage” carry with them some special rules and deadlines.  You can only drop a Medicare Advantage plan and switch to Original Medicare during this special disenrollment period.  If you are switching to Original Medicare, you’ll want to consider adding a Medicare Prescription Drug Plan (“Part D”); the deadline to enroll for this is February 14.

The Alphabet Soup of Medicare – Parts A, B, C and D

Medicare Part A 

Sometimes known as “Hospital Insurance”.  Part A benefits cover inpatient hospital stays, care delivered in a skilled nursing facility, hospice care, and some home health care.  There are rules and guidelines specifying exactly what is covered, for how long, and if special circumstances apply.  There are also deductibles and coinsurances you are responsible for (but these may be covered by some Medigap plans).  Part A is part of “Original Medicare”.   

Medicare Part B

Sometimes known as “Medical Insurance”Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.  Again, rules and guidelines specify what is covered.  Part B is part of “Original Medicare”.

Medicare Part C

Also known as “Medicare Advantage” plans.  These plans are sold by private insurance companies that are approved by Medicare.  Medicare Advantage plans include both Part A and Part B. Most Medicare Advantage plans limit your choices of hospitals and physicians to specified networks.  Monthly premiums, deductibles and copayments or coinsurance vary by plan.

Medicare Part D

Also known as “Prescription Drug Plans”.  Part D adds prescription drug coverage to Original Medicare.  Each plan has a specific formulary which details which drugs are covered, and how much you will pay for different “tiers” of covered medications.  There are rules about going without prescription coverage for specified periods of time and a penalty can be added to the cost of your Part D plan under certain circumstances. Most Medicare Advantage Plans include prescription coverage and you therefore don’t need to sign up for a Part D plan.

Medigap

Also known as “Supplemental Plans”.  Medigap policies are sold by private insurance companies approved by Medicare, and cover some of the payment “gaps” of Original Medicare, like copayments, coinsurances, and deductibles.  Some Medigap policies also offer coverage for services that Original Medicare does not cover, like medical care when you travel outside of the United States.  Medigap policies sold after January 1, 2006 are not allowed to include prescription drug coverage so you’ll want to consider purchasing a part D plan.

Useful Resources to Learn More about Medicare

Here are some useful resources if you have questions about if or when you’re eligible for Medicare, different options available to you, costs for coverage, or anything else related to Medicare:

The Official U.S. Government Site for Medicare: www.Medicare.gov

Centers for Medicare & Medicaid Services: www.cms.gov

State Health Insurance Assistance Programs (SHIPs): provide free help to Medicare beneficiaries who have questions or issues with their health insurance. www.shiptacenter.org

MICHIGAN: Phone: 1-800-803-7174

Online: Michigan Medicare and Medicaid Programs at http://mmapinc.org/

National Association for Area Agencies on Aging: http://www.n4a.org/

Area Agency on Aging Resource Center (Southeastern MICHIGAN):  1-800-803-7174.

Carol Gordon DeVore, M.D.

Carol Gordon DeVore, M.D.

Founder & Patient Advocate at Amazing Healthcare Consultants
Twenty nine years as a physician have brought me great personal and professional satisfaction, but a new passion has driven me to change directions within the healthcare system. I'm acutely aware of the confusion and frustration that patients face as they navigate the healthcare "maze" and look forward to helping patients in many new ways as a private healthcare advocate.
Carol Gordon DeVore, M.D.

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