What you need to know about Medicare open enrollment

If you’re Medicare eligible, what happens during the period from October 15 to December 7 has a make-or-break effect for your health care in the fast-approaching new year. Only during this short period, called Medicare open enrollment, can you enroll, update, or change your benefit selections.

What’s new in Medicare for 2018

Healthcare and about health insurance are prominent topics in the news lately, so nerves about this year’s open enrollment are high. However, those worrisome news reports pertain to the Affordable Care Act (aka Obamacare), not Medicare.

So, the good news is that the Medicare enrollment process is fundamentally the same as in past years, with a few notable exceptions. For instance, those affected by the recent hurricanes are eligible for a special enrollment period that extends the deadline until December 31. There are other changes and adjustments to premiums and costs, some related to the Social Security cost of living increase. The changes and their impact will vary by plan and by personal circumstances, so you should carefully review costs, changes, and provider networks.

What to avoid for open enrollment

The most important thing to avoid is avoidance itself. Yes, you can stay in the same plan by doing nothing, but that might not be the best move for your finances or your healthcare. While the amount of information can be daunting, you owe it to yourself to devote time to reading and understanding your current plan and your options.

Medicarep plan options

The first decision is whether to opt for Original Medicare or a Medicare Advantage plan.

• Original Medicare covers hospital costs and physician costs, referred to as Parts A and B, respectively. With Original Medicare, you can choose any doctor or hospital that accepts Medicare payments, but there are deductibles and significant co-pays, and no annual cap on your out-of-pocket expenses.

• Medicare Advantage plans, by contrast, are administered by a private insurance company. It covers all treatments covered under Original Medicare, and most Medicare Advantage plans also provide drug coverage, something not included in Original Medicare. They also cap your annual out-of-pocket expenses. However, most Medicare Advantage plans are HMOs, which means you’re limited to the physician and hospital network of your plan provider. Thus, changing plans or moving from Original Medicare into a Medicare Advantage plan could mean a change in doctors or hospital. Moreover, the premiums and co-pays for Medicare Advantage plans vary significantly, as do the ancillary coverages, so you need to evaluate the plans in your area carefully.

If you chose Original Medicare, you’ll want to consider purchasing a Medicare supplement insurance policy. These plans, often known as medigap insurance, are provided by private insurance companies and cover many of the out-of-pocket costs of Original Medicare. You should also consider purchasing a Medicare Prescription Drug (Medicare Part D) insurance policy, which provides coverage for prescription medications. You’ll need to compare medigap and Part D policies carefully, to choose ones that best meet your anticipated medical needs.

Medicare resources

If all of this sounds overwhelming, take heart. There are many places to get help online, starting directly at the source, Medicare.gov, where you can find invaluable information on the Original Medicare, Part D, and Medicare Advantage plans available in your area. There are also nonprofits that assist Medicare recipients and their families, such as the Medicare Rights Blog and Medicare Interactive, which, as its name implies, has several interactive tools, videos, and infographics that help demystify the plans and the process.

A frequently overlooked resource is the Senior Health Insurance Assistance Program (SHIP), whose counselors can provide personal insight and assistance. SHIPs are state-level organizations that “provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers.” There are SHIP organizations in all 50 states, staffed by  counselors trained to answer questions, provide guidance, and help with forms and enrollment.