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Everything you need to know about Medicare Open Enrollment

Unsure about Medicare and the health coverage that is right for you?

At Sprouse Insurance we are here to help, we have designed a quick three step guide in order for you to be prepared for this year’s open enrollment process.

1. Understanding Medicare

It is first important to understand the different Medicare parts and why they are important and how they could impact your healthcare.

  • Medicare Parts A and B: Medicare Part A covers inpatient hospital stays, skilled nursing facility care, nursing home care, hospice care, and home health care. Medicare Part B covers outpatient medical costs such as mental health services, preventative care, ambulance services, and others. These two parts make up Original Medicare, which the federal government provides.
    • Most people do not pay a premium for Medicare Part A. Everyone, regardless of employment history will pay a premium for Medicare Part B.
    • Everyone who is insured under either Medicare part is able to go to any doctor at any location that accepts Medicare, without being pre-approved. In most cases people who are insured under either Medicare part do not need a referral for specialist care.
  • Medicare Part C: Medicare Part C is often referred to as Medicare Advantage.
    • Private insurance companies offer Medicare Advantage plans; however these plans often have different rules, costs and restrictions. These can change every year, so if you have this coverage be sure to review your policy annually.
    • Medicare Advantage will cover everything in Medicare Parts A and B, these plans usually include prescription drug benefits.
    • Unlike Medicare Parts A and B, Part C can require a referral for specialist care.
    • If you are enrolled in Medicare Advantage you are ineligible to enroll in Medigap.
  • Medicare Part D: Medicare Part D is also known as Prescription Drug Plans (PDPs).
    • PDPs plans are available from private insurance companies.
    • Most PDPs include coverage for commonly prescribed medications.
    • A person who signs up for Original Medicare (Parts A and B) can choose to add Medicare Part D to their coverage.
  • Medigap: Medigap is supplemental insurance that is offered through private insurance companies.
    • A person who is enrolled in Original Medicare (Parts A and B) is eligible to enroll for this optional additional coverage.
    • It helps pay out-of-pocket expenses, such as coinsurance and Medicare Part A deductibles.

2. Finding the Medicare health plan that is right for you.

The annual Medicare open enrollment takes place from October 15 – December 7. Open enrollment is the only time during the year that you can switch or make changes to your Medicare plan unless you have a special election period during the year. Therefore, if you are currently not satisfied with your existing Medicare plan, you can add, drop, or make changes to your coverage. When doing this, you should consider the following:

  • Future health: If you do not enroll in the additional insurance and prescription drug coverage when you initially sign up for Original Medicare, you may pay a monthly penalty for enrolling later and may not be eligible for additional Medigap coverage.
  • Keeping your doctor: How important is it to keep your current healthcare provider? Original Medicare allows you to keep your current doctor while being enrolled in Medicare Advantage requires you to select a healthcare provider from within their network.
    • The networks for Medicare Advantage are relatively large and it is a possibility that your current provider is in the network, but it is worth looking into before making your decision.
  • Lower premiums or lower out of pocket costs: You will have to determine if you would rather have lower premiums or lower out of pocket costs, this decision will have an impact on the best coverage for you.
    • Medicare Advantage provides lower premiums with more out of pocket costs.
    • Medicare Supplement has higher premiums with lower out of pocket costs.
  • Prescription coverage: Do you need prescription coverage in your Medicare plan? Review this with an insurance agent to see if you need PDP or MAPD.

3.  Advice and Support

  • It is important to invest the time into determining what plan best fits your healthcare needs and to access the assistance you may require in making the most educated decision.
  • There are many online resources that will provide you with the necessary information on Medicare, such as medicare.gov.
  • Or you can schedule a meeting with Julie Hasselbach to discuss your options and get answers to all your questions.
how can we help you?

Contact us at the Sprouse office nearest to you or submit a contact form.

Learn More about Medicare