Author: Erika Burke

Medicare Open Enrollment Period

Review Your Coverage: Take Advantage of Medicare’s Open Enrollment Period

Medicare Open Enrollment PeriodThings happen and things change including your health and sometimes your health plan as well. Take advantage of Medicare Open Enrollment Period (OEP) to review your current coverage and make sure it is still what you need from your health insurance plan.

Open Enrollment Period is October 15 to December 7. So right now is your opportunity to choose the best coverage for your needs. The choices you make now will be effective for all of the new year. You cannot make any changes until next Open Enrollment Period a year from now, unless you qualify for an exception or have Original Medicare with a Medicare Supplement Plan.

Information Checklist for Comparing Medicare Plans

Our information checklist will help you gather the information you need to reference when reviewing your current plan and comparing other available plans.

  1. How is your general health?
  2. Has your health changed considerably in the past year?
  3. Ongoing conditions such as high blood pressure or diabetes?
  4. Vision or hearing problems?
  5. One-time health needs such as illness or injury?
  6. How often do you visit the doctor?
  7. Do you see any specialist?
  8. Do you live in a long-term care residence or skilled nursing facility (nursing home)?
  9. Do you have a planned surgery or procedure coming up?
  10. Review your summary of benefits you periodically get from Medicare or your Medicare Advantage plan, this lists the services you received and the costs.
  11. Prescriptions Drugs (all formularies are different and may affect which plan is the best plan for you)

Factors That Apply to Your Healthcare Plan Usage

Now that you have gathered the items on this checklist, please keep in mind the following factors as it applies to your health and usage of your plan.

  1. Monthly Premium, if any
  2. Deductibles
  3. Co-payments
  4. Coinsurance
  5. Max Out of Pocket (this is your maximum risk if your health dramatically changes during the year)
  6. Does the plan reimburse the Part B Deductible?

Once you have gathered this information, you are ready to start comparing plans at https://medicare.gov.

Are You Eligible for Medicare Yet Still Working? How Does This Affect Your Medicare Coverage?

Great news – whether or not you retire at age 65, you are still eligible for Medicare!

If you, or your spouse, are still employed you may have health insurance through that employer.  The first step you should take, before you enroll in Medicare, is to talk with your human resources department.  You will need to know which kind of health plan you are currently enrolled in and how (if at all) that health insurance will change if you enroll in Medicare.  This information will help you evaluate your Medicare choices and decide which plan is best for you.

Medicare Part A, which is hospital coverage, is premium-free for most people.  It’s a good idea to enroll in Part A as soon as you’re eligible, as long as you qualify for it premium-free.  However, if your employer plan is a Health Savings Account (HSA) – speak to your employer first.  They may stop contributing to your account if you enroll.  This is why it is very important to learn exactly how Medicare will change your current benefits.

Medicare Part B, which is doctor and outpatient coverage, does charge a premium.  For the year 2018, the premium starts at $134 per month with increasing premiums for people with higher incomes.  Many people who are still working and have group health coverage delay enrolling in Part B in order to postpone paying this premium.  Also, the Medicare Part B benefits may be of limited value to you as long as your group health plan is the primary payer of your medical bills.

Also, be aware that Original Medicare – Parts A and B – do not include coverage for your prescriptions, as does a traditional HMO or PPO plan from your employer. For this you’ll need to enroll in a Part D plan that’s available in your state. Medicare prescription drug plans start at less than $20 per month.

As with your employer’s health plan, Medicare does not cover all costs. Parts A and B have co-insurance and deductibles baked in, and they are pretty hefty. After you pay the deductibles, Original Medicare covers 80 percent of approved costs, leaving you on the hook to pay the rest. This can be devastating if you don’t buy supplemental insurance, called a Medicare Supplement or Medigap plan. They are called Medigap plans because they cover the insurance gaps. They can range from about $120 to $500 per month, depending on where you live and how much coverage you need.

PLEASE NOTE:  If you work for a small company (20 employees or less), speak to your employee health benefits administrator before making any decisions.  In this case Medicare is the primary payer and your group health insurance would be the secondary payer.