Medicare Open Enrollment Information

I know, we "Baby Boomers" will never get old...but we will enroll in Medicare! 

Following up from the last post, here is some information that may be helpful during Medicare's annual "Open Enrollment" (the AEP) for Medicare Advantage (Part C) and prescription (Part D) plans.

During the AEP, Medicare beneficiaries can change how they receive health insurance coverage and add, change, or drop prescription drug coverage.  They can make as many changes as they want during this period--with changes taking effect on January 1, 2013.

It is important to note that if you have a traditional Medicare Supplement Insurance policy, it is guaranteed renewable.  That means that no action needs to be taken to continue your coverage other than paying premiums on time.

From October 15 -- December 7, 2012, Medicare beneficiaries can make any of the following changes:

• Change from a Medicare Advantage plan back to Original Medicare.
• Change from a Medicare Advantage plan back to Original Medicare and a Medicare Supplement policy (health history questions may be asked, and some plans may not be available). 
• Change from Original Medicare to a Medicare Advantage Plan.
• Switch from a Medicare Advantage plan to a different Medicare Advantage plan.
• Switch from a Medicare Advantage plan that does not offer prescription drug coverage to a plan that does offer prescription coverage.
• Switch from a Medicare Advantage plan that does offer drug coverage to one that does not.
• Join a stand-alone prescription drug plan.
• Switch from one prescription plan to another.
• Drop prescription coverage altogether.

Another important period to keep in mind is the Medicare Advantage Disenrollment Period from January 1 -- February 14, 2013.  During this time, Medicare benenficiaries can switch from a Medicare Advantage plan to Original Medicare.  Regardless of whether the Advantage plan had drug coverage, beneficiaries also have the option to join a stand-alone prescription drug plan.  Changes made during this period are effective the first day of the following month.

Learning About Medicare

Medicare's Annual Open Enrollment begins October 15 and ends December 7.

The annual open enrollment is an opportunity for Medicare beneficiaries to make changes in their insurance coverage.  It is also a good time for beneficiaries (and perhaps their family members) to learn or be reminded about the way Medicare works.

The Medicare system is divided into four different parts. Each of these parts has a host of options available within them. These four parts are called Medicare Part A, Part B, Part C, and Part D. Here is an overview of the differences between them:

Medicare Part A
Part A is also known as Hospital Insurance because its coverage reduces participant expenses for their hospital stays. Part A covers many costs when a participant is admitted for inpatient care. It also covers a portion of skilled nursing facility, hospice, and even home health care.  However, it is NOT designed for long-term care.  Additionally, participants will be required to pay for coinsurance, deductibles, and some uncovered expenses related to their stays (also known as coverage gaps). These uncovered expenses, or "gaps," may be covered by Medicare Supplement plans (sometimes called Medigap plans). 

Medicare Part B

Part B is also known as the Medical Insurance portion of the Medicare plan because it covers many outpatient services provided by a healthcare provider. Part B also provides coverage for some  services that help participants to stay healthy and decrease the progression of any illnesses.

Part B is also very affordable; the annual premium for Part B was only $99.90 in 2012. However, Part B only pays 80 percent of fees for approved charges, requiring participants to pay for the rest of the cost.  Parts A and B are togeher often called Original Medicare.

Medicare Part C

Part C provides "Advantage Plans." These are typically PPO or HMO plans. Part C plans are administered by private insurance companies that are approved by Medicare. Participants receive their healthcare coverage directly from those private companies instead of from Original Medicare. Generally, Medicare Part C includes Part A and Part B coverage as well as a prescription drug coverage plan.  Some Part C plans do not contain drug coverage.  Part C plans often include benefits not covered by Medicare, such as some vision, dental, or hearing services.  Other benefits might include "Silver Sneakers" or similar programs that provide membership in a fitness center.  These kinds of benefits vary widely between plans.

Medicare Part D

Part D is the program that helps to cover the cost of prescription drugs. Benefits can be included in an Advantage Plan, or they can be purchased as a stand-alone plan for those who have Original Medicare or Medicare and a Supplement plan.

Many Medicare participants find it helpful to speak with an experienced health insurance advisor for more information about their options, and this can also help to ensure that participants get the best healthcare plans for their needs at prices that are right for their budgets.

As an independent agent, I can offer you a choice of several popular plans, depending on your individual needs, preferences or situation.  I also offer periodic educational classes to help Medicare beneficiaries (and those who are about to be) understand how the Medicare program works.  This can also be helpful for those who are assisting parents with the sometimes complicated insurance decisions that arise.

If you are in Sheboygan, Fond du Lac, Winnebago, Manitowoc, Calumet or other nearby counties, you are welcome to attend one of our "Medicare and You" educational classes.  The next scheduled classes are November 1st and 28th at 6 PM and Noberber 13th at 11:30 AM and 6:00 PM.  Classes are at 506 E. Mill St, Plymouth, Wisconsin.  Additional classes may be scheduled elsewhere during the annual open enrollment, so contact me if you would like a complete list.

Give me a call at 920-893-5262 if you would like make an appointment to discuss Medicare-related insurance or if you would like to attend one of our educational classes.

Dorcas George
Insurance Advisor/Coach


Neither Dorcas George nor Veritas Financial are affiliated with the Federal Medicare Program. This is a solicitation of insurance. 


Our "Medicare and You" class is an education event and is only for educational purposes. No plan specific benefits or details will be shared.