It’s that time again for Medicare recipients who want to make changes in your Medicare health and drug plans for 2017. You can make changes only between October 15 and December 7.
If you’re happy with your current plan, you don’t need to do anything. However, if you want to switch between Original Medicare and Medicare Advantage or pick a different Medicare Advantage plan, you can only do so during the Open Enrollment Period.
If you are approaching age 65, you may initially enroll in Medicare during a 7-month period, which extends from 3 months before your birthday month until 3 months after your birthday month. If you don’t enroll during this time frame, you may face late enrollment penalties.
There are four parts to Medicare: Part A (Hospital Insurance); Part B (Medical Insurance); Part C (Medicare Advantage); Part D (Prescription Drugs).
Let’s take a quick look at the pros and cons of Original Medicare versus Medicare Advantage for covered services:
|Original Medicare||Medicare Advantage|
|Can see any doctor or hospital||HMO: Can only see network providers
PPO: Can see network and out-of-network providers; higher co-pays for out-of-network
|Do not need referral from primary care doctor||HMO: Need referral from primary care doctor
PPO: Prior approval varies by plan
|Drugs not covered||Most plans include drug coverage|
|Covers 80% of Part A and Part B||Covers 100% Part A and Part B|
|Cost: Monthly premium, additional premiums for Part D (drugs) and for 20% uncovered Parts A and B (Medicare Supplement/Medigap)||Cost: Varies by plan. May include monthly premiums and visit co-pays.|
If you are on Original Medicare, it only pays for 80% of covered services. Medicare Supplement plans provide coverage for up to the other 20%, depending on the option you choose. These plans are not included in the Medicare Open Enrollment period. Look for my upcoming article on Medigap.
Original Medicare gives you more provider choice, but to have comprehensive coverage of Medicare allowed hospital, medical and drug costs, you need to purchase Part D and Medigap plans. Therefore, your monthly costs will be higher than a Medicare Advantage Plan.
Many doctors are opting out of Medicare because of the low reimbursement rates. If you are on Original Medicare and want to see an opted-out doctor, you can pay at the time of visit and submit your invoice and claim form directly to Medicare and Medigap for reimbursement.
If you choose Original Medicare, you will need to purchase a Part D plan to cover your prescription drug costs. The Open Enrollment Period for making changes in drug plans is the same as for Original Medicare/Medicare Advantage. Look for my upcoming article on Part D.
For more information on Medicare, visit consultkahn.com/medicareconsult.
If you are a United States citizen, have you registered for Medicare? Do you have any questions about the different levels of coverage? Do you understand the pros and cons between Original Medicare and Medicare Advantage? Please leave your comments in the section below.