Understanding Medicare Open Enrollment

Nov 03, 2022

• Share on Facebook
• Tweet
• Pin it
• Share on LinkedIn

Medicare enrollment is October 15 through December 7 annually. During this annual window, Medicare plan enrollees can review and change Medicare coverage. During this period, you can join Parts of Medicare, and freely join, switch, or drop a Medicare Advantage or Part D health plan. Below are helpful tips on what you need to know before making your plan choices.

Is Open Enrollment the Same for All Plans?

Your first Open Enrollment Period starts as soon as you are at least age 65 and enroll in Medicare Part B, and it lasts for six months. During this period, you can apply for a Medicare Supplement Insurance policy and cannot be denied coverage or charged more for your plan based on your age or pre-existing health conditions.

Note: You also enroll in Medicare Part A when at least age 65. Part A covers the cost of inpatient hospital stays if you are admitted to a contracted hospital, following a doctor’s order. Part A includes inpatient mental health services, stays at a skilled nursing facility, hospice, and some home health care services. As a general rule, after a person enrolls in Medicare, they do not have to re-enroll annually. This is true for enrollment in Original Medicare (Part A and Part B) or a Medicare Advantage plan offered by private insurance companies. A person does not usually have to re-enroll or fill out paperwork annually if they are satisfied with their coverage.

Annually, Open Enrollment is in the fall when you can enroll in a health insurance plan for the next calendar year. Open Enrollment for 2022 is over, but you may still be able to enroll in a Marketplace health insurance plan for 2022 if you qualify for a Special Enrollment Period. You’re eligible if you have certain life events, like getting married, having a baby, or losing other health coverage. The upcoming Fall Open Enrollment is for 2023.

Job-based plans may have different Open Enrollment Periods. Check with your employer. You can apply and enroll in Medicaid or the Children's Health Insurance Program (CHIP) any time of year.

When is it too late to enroll in Medicare?

You may owe a late enrollment penalty if, at any time after your Initial Enrollment Period is over, there's a period of 63 or more days in a row when you don't have Medicare drug coverage or other coverage.

How to Assess Cost Savings for Open Enrollment Plan Changes?

During Open Enrollment, you can assess the following for cost savings:

• Switch Part D prescription drug plans.
• Switch Medicare Advantage plans, which offer health (and often drug) coverage through private insurers.
• Switch from Original Medicare, administered by the federal government, to Medicare Advantage.
• Switch from Medicare Advantage back to Original Medicare.

Note: Be sure to weigh all costs associated with a plan. Cheaper plans may save you money month-to-month but likely result in higher out-of-pocket expenses, especially if services are provided at an out-of-network facility or clinic. Avoiding some out-of-pocket expenses may save you money in the long run.

Checklist for Preparing for Open Enrollment

1. Familiarize yourself with the different parts of Medicare and how they work together.
2. If you currently have a Medicare Advantage Plan (also known as Part C), is that still working well? Are the health care providers you prefer in-network? Make a point of opening all mail from the private insurance provider that arrives in September and October so you can be on top of any changes to premiums, deductibles, copays, formularies, and provider groups.
3. If you have a Medicare Supplement Insurance policy (also known as Medigap), make sure you pay attention to any premium increases. At some point, you may need to consider switching to a different Medigap policy, dropping this policy, or switching to an Advantage Plan.
4. If out-of-pocket spending on hospital visits, prescription drugs, and doctor’s appointments has increased in the current year because you don’t have Medigap, Medicare Part D, or a Medicare Advantage Plan, now is the time to add up those costs and decide whether a different mix of coverage would be a more affordable solution. It’s also worth looking into public programs that can assist with covering health care costs and premiums.
5. Go to the SHIP National Network website and look up the location of your local State Health Insurance Assistance Program (SHIP). SHIP counselors are usually located at Area Agencies on Aging (AAAs). They often put on public presentations each fall that cover changes in Medicare for the coming year and offer one-on-one counseling. All SHIP services are offered free of charge. Now is the time to become best friends with your local SHIP counselors so they will remember you if you have a last-minute question.
6. Make sure you have up-to-date information about your current health status and future needs/concerns. Are you due for an appointment with your primary care physician? Will you need a referral to see a specialist in the near future? Would adding dental, vision, or hearing coverage be beneficial in the coming year?
7. Make sure you have a current list of all medications. If any are brand names, ask your doctor or pharmacist if there are generic equivalents available. If not, be prepared to request an exception from your Part C or Part D plan in case the brand-name medication isn’t part of their formulary.

Help Yourself by Making Sure You are Prepared

Your caregivers at William Newton Hospital want you to be prepared and make the best plan choices. For example, you may be able to get more savings and lower costs on Marketplace health insurance coverage due to the American Rescue Plan Act of 2021. Under the new law:

• More people than ever before qualify for help paying for health coverage, even those who weren’t eligible in the past.
• Most people currently enrolled in a Marketplace plan may qualify for more tax credits.
• Health insurance premiums after these new savings will go down.

Learn more at HealthCare.gov

This article was submitted for the "Weekend Check-Up," a regular health column in the Cowley CourierTraveler penned by employees and friends of William Newton Hospital.