For people who want to tweak their Medicare coverage, the time to do it starts Sunday.
The program’s fall open enrollment period runs from Oct. 15 through Dec. 7. You should evaluate your current coverage even if you’ve been happy with it.
“Insurance companies make changes every year,” said Elizabeth Gavino, founder of Lewin & Gavino in New York City, and an independent broker and general agent for Medicare plans.
In simple terms, the upcoming seven-week period is for adding or changing coverage related to Medicare Part C (known as an Advantage Plan) and Part D (prescription drug coverage). This is generally the only time of year you can make changes.
WHAT ARE ALL THOSE MEDICARE PARTS?
Part A. This covers inpatient stays at hospitals, skilled-nursing facilities and the like. As long as you’ve paid into the system by working the equivalent of about 10 years, you won’t pay any premiums. If not, you’ll have to pay for it.
Part B. Everyone pays premiums for this coverage, which generally includes outpatient services and supplies. Higher incomes generate higher premiums: If you’re single and have an income of more than $85,000 or are married with a joint income of at least $170,000, you will pay more.
Part C. Also called Medicare Advantage, the program lets people choose from a Medicare-approved private insurance plan instead of Parts A and B. Each plan comes with differing variables, ranging from coverage to deductibles and co-pays.
Part D. This is prescription-drug coverage. This often ends up being included with an Advantage Plan. If you have Parts A and B instead of an Advantage Plan, you can purchase Part D coverage separately. Although this is voluntary coverage, if you don’t sign up during your initial enrollment time and change your mind later (if you don’t meet an exclusion) you’ll likely pay a penalty that will last forever.
Note: Fall enrollment is different than the initial sign-up for Medicare. In that case, you get a seven-month window that starts three months before the month in which you turn 65 and ends three months after your birth month.
Generally speaking, you must sign up for Medicare Part A (in-patient coverage) and — unless you meet certain exclusions — Part B (outpatient care) during initial enrollment. Those two parts are often referred to as Original Medicare. You also can sign up for Parts C and D during your initial signup period.
Don’t assume your coverage isn’t changing
If you get mail from your insurance company, open it. Every year, your Advantage Plan insurer and prescription drug plan provider must alert you if anything about your coverage is changing. While the insurers are federally regulated, the specifics of their options can vary greatly from plan to plan, county to county and from year to year.
Even if you don’t notice anything in the mail, you need to double-check your coverage. Modifications to your Advantage plan could affect things like your premiums, deductibles, co-pays, covered services, participating doctors and covered prescriptions.
“You need to make sure you can still see your doctors and make sure your medications won’t be more expensive,” Gavino said.
“You need to make sure you can still see your doctors and make sure your medications won’t be more expensive.”
Most Advantage Plans include prescription drug coverage to satisfy Part D requirements. Whether you have a prescription plan separately or an Advantage Plan that includes it, you can check medication prices on the Medicare website at its Medicare Plan finder.
To make sure your doctor is still in-network, you have to check with the insurance company that offers the plan. You can either visit the provider’s website or call. If you work with an agent, that person also should be prepared to help you.
Same goes for people initially signing up for an Advantage Plan or prescription drug coverage: Make sure your doctor and drugs are included.
Not comparison shopping
The variety of plans available largely depends on where you live. The more rural the area, the more likely you are to have fewer choices for an Advantage Plan. In fact, in 147 counties located mostly in the western United States (including Alaska), residents have no Advantage Plan available, according the Kaiser Family Foundation. In those cases, people use Original Medicare (Parts A and B) and have options for prescription drug coverage.
If you do have choices, it’s well worth your time to compare plans. Maybe last year you picked an Advantage Plan or prescription drug plan due to its lower-cost medications or the location of a participating pharmacy or specialist. There’s a chance those reasons no longer apply, depending on any changes made to the plan.
Don’t assume your health won’t change
While you might be healthy now and take no daily medications, there’s a good chance it will change, whether due to aging, an accident or an unanticipated medical event.
“It’s important to make sure your plan has strong coverage for unplanned emergencies and changes to your health,” Gavino said.
If you didn’t have Part D and now decide you want it, you might face a penalty for waiting (some exclusions apply.)
In other words, assuming your health will never deteriorate can end up being costly.
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