Medicare Advantage Open Enrollment Ends this Month

By Charlestien Harris

Turning 65 last year was a huge milestone for me. Like a hawk, I zeroed in on all the information I could get my hands on months before my birthday. Guess what – it was still pretty mind-boggling to me. I visited my local Social Security office, and they provided me with a copy of the publication Medicare and You 2025. As if understanding Medicare and how it works isn’t complicated enough, this federal health insurance program for seniors aged 65 and older, and people with specific disabilities or other described conditions, has multiple annual enrollment periods.

There are two very important open enrollment times of the year to take special note of. The main open enrollment period runs from Oct. 15 through Dec. 7, while the Medicare Advantage open enrollment period runs from Jan. 1 to March 31. There are a few facts that you need to consider when choosing your Medicare benefit packages, so let’s take a look at some of those considerations.

1. Medicare Advantage Plans: A Medicare Advantage Plan is a health plan that provides Medicare Part A, Part B, and typically Part D coverage. These plans are also known as Medicare Part C. One of the two main types of Medicare, they are offered by private insurance companies that are approved by the federal Medicare program. The other type of Medicare, Original Medicare, is the traditional government-managed health care coverage. If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. You can learn more about those rules at www.medicare.gov. Understanding this first step is critical to your ability to choose from the vast array of choices available in the Medicare system of plans.

2. Available Options: During the current enrollment period, consumers with Medicare Advantage plans (with or without prescription drug coverage) have the option to do one of the following:

• Switch to a different Medicare Advantage plan (with or without drug coverage).
• Switch from Medicare Advantage back to Original Medicare (with or without also enrolling in a drug plan).

Always check to see whether or not you can switch to a different plan. Be aware of possible penalties, and keep a close eye on these open enrollment dates because missing these “open window” timelines can greatly affect the quality of healthcare you have access to. You most definitely do not want to end up with gaps in your medical services, especially when you have chronic conditions that require immediate or constant medical attention.

 3. Research the Features of a Plan: Medicare Advantage plans, also known as MA plans, are offered by private companies that are approved by Medicare. Some of these plans may offer different benefits, so make sure the plan you choose will cover your specific health needs. There are some plans that offer additional benefits like dental, vision, hearing, and wellness programs. Most of these plans include Medicare prescription drug coverage (Part D), but check to make sure the plan you choose does. MA plans may have different out-of-pocket costs and rules than Original Medicare. Still, other MA plans may require members to use providers in their network and get referrals to see specialists.

4. Other Options Available: Of course, like any other area of medical services, there are other options that you may not be aware of. Listed below are those options and a brief description of each:

• Medicare Cost Plans: A type of managed care plan within Medicare Advantage (Part C) where you pay a set monthly premium, and then you are responsible for a copay or coinsurance when you receive medical services, essentially meaning you “pay as you go” for your healthcare costs within the plan’s network. Typically, these plans are only available in certain, limited areas of the country, so be sure to check to see if they are offered in your area.
• Demonstration/Pilot Programs: Demonstrations and pilot programs (also called “research studies”) are special projects that test improvements in Medicare coverage, payment, and quality of care. They’re usually only available for a limited time, for a specific group of people, or are offered only in specific areas. Check with the demonstration or pilot program you’re interested in to find out how it works.
• Program of All-Inclusive Care for the Elderly (PACE): PACE is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility. PACE covers all Medicare- and Medicaid-covered care and services, and anything else the health care professionals on your PACE team decide you need to improve and maintain your health. This includes prescription drugs and any medically necessary care.

Of course, with any changes that you make with your health care plans, careful research should be done so you will be armed and informed with the best information possible. Then you can make the best decision when choosing which Medicare Advantage plan is the proper fit for your specific healthcare needs.

For more information on this and other financial topics, you can email me at [email protected] or call me at 662-624-5776.

Until next week – stay financially fit!