If you’re like most people, the information you receive about Medicare through the mail, from insurance agents, or talking with friends, family, and co-workers, is confusing! And the abundance of conflicting information can leave you anxious, worrying that you’ll do the wrong thing like missing a key enrollment period or incurring hefty penalties.
- Joe says I should wait until Open Enrollment in the fall to enroll
- A brochure I received in the mail says I HAVE to enroll in Medicare at age 65
- My neighbor says if I have health insurance through my employer, I don’t need to enroll in Medicare
- My cousin says I don’t need to enroll in Medicare Part D if I’m not on any medications now, and that I can enroll in a Part D at any time
- My best friend says to just enroll in a cheap plan now since I’m healthy, that I can always change to a better plan during Open Enrollment
One area of confusion for many people is the various enrollment periods for Medicare. Very few people are clear on which enrollment period is for what situation, and what the implications are if you miss the relevant enrollment period.
Because Medicare Open Enrollment is approaching, we decided this would be a good time to provide you with the information you need regarding this enrollment period.
Medicare Open Enrollment occurs every year from October 15th through December 7th. The term “Open Enrollment” seems to imply that anyone can enroll in Medicare at this time. In reality, Open Enrollment is for making CHANGES to your existing Medicare coverage–primarily your Medicare Advantage Plan (or Medicare Part C plan), or your Medicare Part D prescription drug plan. Here is what you can do:
- Switch from one Medicare Advantage plan to another Medicare Advantage plan
- Enroll in a Medicare Part D prescription drug plan
- Switch from one Medicare Part D prescription drug plan to another
- Switch from an Original Medicare supplement plan to a Medicare Advantage plan
When you do make a change in your coverage, the new plan will be effective January 1.
You can NOT change from a Medicare Advantage plan to an Original Medicare supplement plan during Open Enrollment. You can only do this from January 1st through February 14th every year. And if you’ve been on your Medicare Advantage plan for 12 months or longer, you MAY NOT QUALIFY for an Original Medicare supplement plan if you have health issues. This is one reason the decisions you make when you first become Medicare eligible are so important– you may not be able to make changes in the future.
Why would you want to make changes to your coverage? In most cases people change their plans due to an increase in the premium of their current plan, or an increase in the copay amounts. But another reason you might want to change from one Advantage plan to another is the network of providers may have changed. For example, if the group of doctors you are currently seeing decide to drop out of your plan’s network. This also applies to Medicare Part D plans–the co-pays may go up for your medications, or perhaps you are on new medications which are very expensive on your current plan; or the pharmacy you like is no longer in the plan’s network.
To make a change in your Medicare coverage you simply enroll in the Medicare Advantage plan or Part D Prescription plan you want, and you will automatically be dropped from your current plan.
So who should you listen to? Our firm has retained the services of an expert who specializes in this area of planning. Eileen Hamm has the experience and knowledge to provide you with the advice, guidance, and recommendations that will get you through the confusing world of Medicare. Since she does not sell any Medicare products, her advice is objective with no underlying pressure to “sell you.” We pay her firm a retainer fee, as a value-added benefit to you for being our client so there’s NO charge to you. If you’d like to take advantage of this service, contact us and we’ll make an introduction.
(Eileen and Allen Hamm are the co-founders of Superior LTC Planning Services. For the past 25 years, they have been assisting the clients of financial advisors with issues related to Medicare and long-term care. Eileen has a background as a registered nurse and has been in the health insurance field for the past 20 years. Allen is the creator of the Smart LTC Planning process and the author of “How to Plan for Long-Term Care.”)