Medicare 101: What You Need to Know to Sign Up, Make Changes During Open Enrollment

By Marc Reynolds

While it has been around for half a century, Medicare is still something new for thousands of Americans who turn 65 every day and become eligible to enroll into the national health insurance program.

So, if you’re eligible for Medicare, be ready to learn Medicare terminology before deciding on a plan that best fits your health needs.

For initial enrollment, you can sign up during the seven-month period that begins three months before the month you turn 65. If you don’t sign up when first eligible, you may have to pay a late enrollment penalty for as long as you have Medicare.

If you’re already enrolled, be ready to go over that glossary again, especially if you’re thinking of switching Medicare plans. If you’re reading this now, don’t wait too long. Open enrollment for Medicare runs from Oct. 15 to December 7.

Learn the Medicare plans, study your options:

Medicare coverages can be very confusing. For example, do you know the difference between Original Medicare, Medicare Advantage and Medicare Supplemental Insurance (Medigap)?

Here is a list of terms to learn and steps you can take to better understand your options and make sure you get the most from your health plan benefits.

First, there are two main ways to access Medicare, either through Original Medicare or a Medicare Advantage plan. It is also important to know about prescription drug coverage and supplemental plans.

• Original Medicare is made up of two parts. Part A provides your hospital insurance. Part B provides medical insurance for things like doctor visits and checkups. Everyone can have Part A, regardless of whether you’re still employed. If you’re still working at 65 and are covered by your employer’s health insurance, then in most cases you don’t need to sign up for Part B yet. Once you stop working, you’ll have a special enrollment period of eight months after you employment ends in which to sign up for Part B.

• Medicare Advantage plans, also known as Plan C, are typically HMO (Health Management Organization) or PPO (Preferred Provider Organization) products. These insurance plans combine the benefits of Part A and B and in most cases include prescription drug coverage (Part D) and may include extra benefits and services for an additional cost. These plans usually require the patient to access a limited physician network for services.

• Prescription drug coverage: Medicare Part A and Part B do not cover prescription drug benefits. For prescription drug coverage you can enroll in a prescription drug coverage or Part D plan.

• Supplemental insurance (Medigap Plans): This coverage is an alternative to Medicare Advantage plans and allows individuals to customize their health plan coverage. These plans help fill “the gap” by partially or fully covering expenses that would normally be payable by the patient under original Medicare. Supplemental plans are only available to purchase for people who are enrolled in original Medicare. People with a Medicare Advantage plan cannot buy Medicare supplemental insurance.
  

Once you have evaluated your choices, choose the Medicare plan that is the best fit for you and complete the enrollment process. You may be able to sign up in person with a broker, through the mail, over the phone or online.

Already enrolled but thinking of switching plans?

If you’re enrolled already, you’ll need to decide whether or not you want to change your coverage before the Dec. 7 deadline. Review your existing health and drug benefits, and pay attention to any changes announced for the coming year.

Your current insurance provider will send information to let you know what, if any, changes will be made to your Medicare coverage in 2016. Review these carefully to ensure the providers, services and medications you need are covered and at what cost. Check your premiums, coinsurance, co-payments, deductible and out-of-pocket limits, and ask yourself whether another plan would better suit your needs in 2016.

If you have employer or union coverage, check with your plan’s benefits administrator before making any changes to your coverage. Otherwise, you could lose coverage for yourself and your dependents.

Finally, take advantage of the benefits your plan offers. Your Medicare coverage offers more than just sick care. Review your benefits and take advantage of wellness and preventive services such as an annual exam, weight and blood pressure check, flu shots and more.

Marc Reynolds is corporate senior vice president for payer relations at Scripps Health. To Your Health is brought to you by the physicians and staff at Scripps Health. For more information about health plans with access to Scripps, please visit www.scripps.org/options or call (858) 223-1792.