If re-shopping Medicare options feels like swirling down a drain in alphabet soup, you are not alone. It is November 11, 2015–Veterans Day and near the middle of Medicare’s Annual Enrollment Period. Medicare recipients have until December 7, 2015 to make changes for plans that will be effective January 1, 2016.
What can one do during the Annual Enrollment Period, or AEP? If you only have Medicare Parts A and B, you can choose to:
- Add a Medigap, or supplemental, plan and a prescription drug plan (PDP) unless you have creditable prescription drug coverage elsewhere, such as through the Veterans Administration. You may need to go through medical underwriting to add a Medigap plan.
- Add a Medicare Advantage plan with or without prescription drug coverage depending on the type of plan and whether you have creditable drug coverage elsewhere.
Part A is for hospital coverage and Part B is for medical insurance. Part B has a premium of $104.90 for most Americans, and, if a person is signed up for it, that usually comes directly out of their monthly Social Security income.
If you have at least one of Parts A or B, you can choose to add a PDP only–Medicare does require prescription drug coverage, also known as Medicare Part D.
Medicare.gov is an excellent resource for anyone shopping for different Medicare options for next year or anyone who is or will be new to Medicare.
7 things to know about Medigap, or Medicare Supplemental Insurance:
- You must have both Medicare Part A and Part B.
- If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins. You may need to finish the year with your MA or MAPD.
- You will pay a private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
- Medigap policies cover one person. If you and your spouse or partner both want Medigap coverage, you’ll each have to purchase your own policy.
- You can buy a Medigap policy from any insurance company licensed in your state to sell one.
- Any standardized Medigap policy is guaranteed renewable even if you have health problems. However, you may have to go through medical underwriting to purchase a Medigap policy the first time unless your meet certain conditions, such as being new to Medicare or new to Part B. Missouri has an Anniversary Rule that gives Medicare recipients a guaranteed issue window for a Medigap plan each year…if they already have a Medigap plan.
- Medigap policies sold after January 1, 2006 do not include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan, also known as a PDP and Part D.
7 things to know about Medicare Advantage plans:
- You still have Medicare rights and protections and continue to get complete Part A and Part B coverage through the plan.
- You can only join a plan at certain times during the year. If the effective date is January 1, then you enrolled in the plan for that calendar year.
- Unlike Medigap plans outside of certain guaranteed-issue exceptions, you can join a Medicare Advantage Plan even if you have a pre-existing condition, except for End-Stage Renal Disease (ESRD).
- If you see a doctor, other health care provider, or go to a facility or supplier that doesn’t belong to the plan’s network, your services may not be covered, or your costs could be higher.
- Providers can join or leave a plan’s provider network anytime during the year. Your plan can also change the providers in the network anytime during the year. If this happens, you may need to choose a new provider.
- Medicare Advantage Plans are not allowed to charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
- Medicare Advantage Plans have an annual limit on your out-of-pocket costs for medical services. If you reach this limit, you’ll pay nothing for covered services for the remainder of the year. This limit may vary between Medicare Advantage Plans.