UNITED STATES—Toni, this is my first Medicare Open Enrollment Period, and a few weeks ago I read your Medicare Open Enrollment article explaining what the fall enrollment time is about.  I’m still confused about what I need to do.

I don’t know anything about the Open Enrollment process or how I can make a change.   How do I find out which options are right for me? I have health problems and I’m concerned–which Medicare health plan and prescription drug plan do I choose?  I also want to be prepared before marketing material and telemarketers bombard me. I would really appreciate your help!

Thanks, Phyllis from Denver.

Hello Phyllis: Every fall during Medicare’s Open Enrollment Period (OEP) beginning Oct. 15 ending Dec. 7, the Toni Says Medicare team is asked for help in finding the correct option to enroll in during this time.   Let me discuss what you can do, Phyllis, during Medicare’s OEP.

Which Medicare option is right for those making changes during OEP depends on their health, prescriptions and whether they want to change their medical providers or facilities. They may be someone who has a history of serious health issues treated with expensive brand name prescription drugs or someone who goes to the doctor once a year for a physical and takes inexpensive generics.

Phyllis, I would say to take your time and research your options. Below are steps the Toni Says team uses when helping clients during Medicare’s OEP.

Step #1:  Decide if you want Original Medicare (Parts A & B) or  Medicare Advantage Prescription Drug Plan” (MAPD) Part C.

  1. Ask your doctor’s office which plan is recommended. Most doctors accept Original Medicare, but not all accept Medicare Advantage plans. If you have a doctor/ medical facility that is in a Medicare Advantage plan’s provider directory, don’t forget to call that specific doctor’s office/facility to verify that the provider/facility is still accepting that specific Medicare Advantage plan in the upcoming calendar year.
  2. The main difference between Original Medicare and Medicare Advantage plans is that Original Medicare works only with Medicare and the Medicare Supplement selected pays the deductibles or coinsurances.  Medicare Advantage plans (MAPD) also called Part C, are administered by private insurance companies that are approved by Medicare and are primarily HMO and PPO plans.
  3. When choosing a Medicare Advantage plan, you must use that specific insurance company’s card, not your Medicare card, to pay claims. With Original Medicare and a Medicare Supplement, you will use your Medicare (red, white, and blue) card to pay claims with the Medicare Supplement paying the Medicare out-of-pocket.

Step #2:  Decide if you need to enroll in or change your current Medicare Part D plan during Medicare’s OEP.

  1. If you want Medicare Prescription Drug coverage to go along with Original Medicare, then you must enroll in a stand-alone Medicare Part D plan, and there may be a monthly premium.
  2. If you choose a Medicare Advantage plan, make sure that the plan has Medicare Part D Prescription Drug coverage included to keep you from receiving a Medicare Part D penalty for not enrolling in a Medicare prescription drug plan.
  3. Verify that your brand-name/generic drugs are in the selected Medicare Advantage plan or stand-alone Part D plan’s formulary.

Step #3: Remember, Medicare’s Open Enrollment has a deadline, and you have from Oct. 15 to Dec. 7 to change your Medicare Advantage (MAPD) plan or stand-alone Medicare Part D plan and the change will begin Jan. 1.

  1. If you miss the Dec. 7 deadline, you will have to wait until the next year’s Medicare OEP.
  2. Medicare’s OEP is only for enrolling or changing MAPD or Medicare Part D plans. (One can change Medicare supplement, long term care, or dental plans any time of year.)

 Phyllis, it is very important during Medicare’s OEP that you take your time to explore your Medicare options. Call the Toni Says Medicare hotline at (832) 519-8664 or email info@tonisays.com for assistance with Medicare Open Enrollment questions or any concerns you may have.  Toni’s “Medicare First Steps,” available at www.tonisays.com details various situations during Medicare’s Open Enrollment Period.

—–

Toni King is an author and columnist on Medicare, Social Security, and long-term care issues. She has spent nearly 20 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.

RELATED ARTICLESMORE FROM AUTHOR