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How to Make Sense of the Medicare Annual Election Period

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Medicare’s Annual Election Period runs through December 31.

This is when people enrolled in or eligible for Medicare have the opportunity to reevaluate their healthcare options and sign up for or switch their current coverage in Medicare Advantage and Medicare Prescription Drug plans.

In order to make certain the Medicare Advantage coverage you choose is best suited to you, there is helpful information available through many sources.

A first step: Be sure to look for your Annual Notice of Change, which will advise about upcoming changes to your existing plan. Review this document carefully so you can make an informed decision on remaining in your current plan or enrolling in a plan that may better meet your personal healthcare needs.

Even in today’s economy, when it comes to choosing healthcare and prescription drug plans, there are important things to consider beyond just the price.

In fact, it’s worth taking the time to learn the ABCs – and D’s – of choosing a plan.

Those letters stand for the four parts to Medicare:

Medicare Part A is hospital coverage and covers inpatient hospital care, inpatient stays in most skilled nursing facilities, Hospice and home health services.

Medicare Part B is medical coverage for doctor and clinical lab services, outpatient and preventive care, screenings, surgical fees and supplies, and physical and occupational therapy.

Medicare Part C (also called Medicare Advantage) combines Parts A and B. It is an alternative to getting Medicare Part A and Part B coverage separately. Medicare Advantage plans combine hospital insurance (Part A) and medical insurance (Part B) into one plan, and can also be combined with Part D prescription drug coverage.

Medicare Part D is prescription drug coverage and can be a stand-alone plan (not joined with other insurance) or, it can be combined with a Medicare Advantage plan.

When choosing Medicare Advantage coverage, here are some things to consider:

Compare – Your health, finances or coverage may have changed since last year. Compare your current plan with other available coverage options to see if there is a better choice.

Cost – How much are your current premiums and deductibles? How much will you pay for hospital stays or doctor visits?

Doctor and Hospital Choice – Does your current doctor accept the healthcare plan you are considering? If considering a PPO (Medicare Advantage Preferred Provider Organization) or HMO (Health Maintenance Organization) plan, would you be limited to choosing your hospital and healthcare providers from a network? Would you need a referral to see a specialist? If considering choosing a new physician, call and find out if they are accepting new patients.

Prescription Drugs – What are your prescription drug needs? Do you need to join a Medicare Advantage plan with prescription drug coverage or a stand-alone Medicare Part D prescription drug plan? What will your prescription drugs cost under each plan and does each plan provide coverage in the coverage gap (the “donut hole”)? Are your drugs covered under the plan’s formulary (drug list)?

Quality – Does the plan focus on prevention, as well as treating illnesses? Are your doctors and pharmacists working together to address your healthcare needs?

Convenience – Where are doctors’ offices located? What are their office hours? Which pharmacies are available and nearby? Do you know who to call when you have questions? Will you be able to talk with one person who understands your overall health needs?

There are many excellent insurance agents who can help answer your questions regarding the Annual Election Period. With so many choices available to people with Medicare, make sure you are educated on the subject and understand your options.

For more information, visit www.medicare.gov.

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