By: Liz Fitzgerald, health enews
A news service from AdvocateAuroraHealth
Medicare Annual Open Enrollment also referred to as the Annual Election Period (AEP) occurs every year from Oct. 15 to Dec. 7. During this period, Medicare enrollees can join, drop or change their Medicare health plan and prescription drug coverage to better meet their needs. Changes made during AEP take effect Jan. 1 of the following year.
Dr. Michael Malone, Medical Director of Aurora Senior Services and Aurora at Home recommends 5 key reminders individuals can take to ensure they understand their Medicare coverage options before the AEP deadline.
Tip 1: Know your Medicare A, B, C and D’s
Medicare can be understood by breaking it down into four parts says Dr. Malone.
Original Medicare is comprised of Part A (hospital insurance) and Part B (medical insurance). These plans are made available directly through the Federal government.
Part C refers to Medicare Advantage plans. These plans incorporate your Part A, Part B and often Part D – prescription drug coverage into one plan. For these plans, Medicare pays a private insurance company to provide your health care coverage with a Medicare Advantage plan.
Part D refers to Medicare prescription drug coverage. Individuals with Original Medicare and a Medicare Supplement will need to purchase a Medicare Part D prescription plan separately. For people joining a Medicare Advantage plan, a Medicare prescription plan is often included with the Medicare Advantage coverage. Individuals should carefully evaluate Part D coverage and enrollment time periods as if you decide to enroll late for Part D prescription drug coverage, a penalty may be assessed.
View this chart to help you understand your Medicare coverage choices.
Tip 2: Understand commonly used Medicare insurance terms
Equally important, understanding frequently used Medicare insurance definitions can help you before starting the enrollment process. Here are some key terms as defined by the Centers for Medicare & Medicaid Services (CMS). For a full list of terms, visit the CMS glossary at www.medicare.gov/glossary.
- Coinsurance: An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
- Copayment: An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor’s visit or prescription drug.
- Deductible: The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
- Medigap policy: Medicare Supplement Insurance sold by private insurance companies to fill “gaps” in Original Medicare coverage.
- Out-of-pocket costs: Health or prescription drug costs that you must pay on your own because they aren’t covered by Medicare or other insurance.
- Premium: The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.
Tip 3: Understand prescription drug coverage
Most people assess their prescription drug coverage only when a complication arises.
“I strongly encourage individuals to thoroughly review their Medicare plan each year to ensure their prescription drugs are covered to avoid any unexpected problems,” says Dr. Malone.
Even if you do not currently take any prescription medications, you may still want to enroll in a stand-alone Part D plan or Medicare Advantage Plan (MAPD) as you never know when you may need prescription drug coverage. The Medicare Part D program helps to cover the costs of the prescriptions you take.
Use the Medicare plan finder at Medicare.gov/plan-compare to review if your prescription drugs are covered.
Tip 4: Don’t delay care
As adults continue to age, it’s crucial to not delay routine care, especially during the COVID-19 pandemic. Routine exams keep you well. Make a plan to stay healthy by scheduling your Medicare annual wellness visit (a benefit typically covered each year) to stay on top of your wellbeing. Check your plan details to confirm details of coverage.
Also consider virtual visits as an option to see a provider remotely. If you need help accessing virtual technology, don’t hesitate to reach out to a family member who may be able to assist you suggests Dr. Malone.
Tip 5: Check out available Medicare resources
Most importantly, remember there is help available. Use these tools to learn more.
- For more information on Medicare resources and related services in your area:
- If you are a resident of Illinois, visit com/Medicare.
- If you are a Wisconsin resident, visit org/Medicare.
- To view and compare 2023 available plans in your area, visit the Medicare plan finder at medicare.gov/plan-compare or call 1-800-MEDICARE after October 1.
- State Health Insurance Assistance Program (SHIP) counselors are available to assist you. To contact SHIP, visit www.shiptacenter.org or call 877-839-2675. TTY users can call 1-877-486-2048.
This article originally appeared on health enews.
