UNITED STATES—Toni, this is my first Medicare Annual Enrollment Period, and I don’t know anything about this process. How do I find out which options are best for me? I have health problems and I’m concerned about making a change. Which Medicare health plan and prescription drug plan do I choose? Will I have to answer health questions to qualify? Currently, I am being bombarded by marketing material and I would really appreciate your help! Thanks, Frank from San Antonio, TX.
Hello Frank, Medicare Annual Enrollment Period (AEP) is from October 15 to December 7 and the Toni Says Medicare team is asked this question at least 20 times a day during Medicare’s AEP. (I discuss it at length in Chapter 6 of my book, Medicare Survival Guide Advanced edition.)
Which Medicare option is right for you depends on your health and financial situation. You may be someone who has a history of serious health issues with expensive brand name prescription drugs or who goes to the doctor once a year for a physical and takes inexpensive generics. Take your time and research your options.
Below are steps the Toni Says team uses when helping clients during Medicare’s AEP.
Step #1: Decide if you want “Original Medicare” (Parts A & B) or “Medicare Advantage” (Part C) plan.
- 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 that is in a Medicare Advantage plan’s provider directory, make sure you call to verify that the office is still accepting that specific Medicare Advantage plan in the upcoming calendar year.
- 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 (or you pay, if no supplemental policy is selected). Medicare Advantage plans are also called Part C. They are administered by private insurance companies that are approved by Medicare and are primarily HMO and PPO plans.
- When choosing a Medicare Advantage plan, you must use that specific insurance company’s card, not your Medicare card.
Step #2: Decide if you need to enroll in or change your current Medicare Part D plan during Medicare’s Annual Enrollment Period (AEP).
- If you want Medicare Prescription Drug coverage to go along with “Original Medicare” then you must enroll in a standalone Medicare Part D plan and there is a monthly premium.
- If you choose a Medicare Advantage plan, make sure that the plan has Medicare Part D Prescription Drug coverage included to keep from receiving a Medicare Part D penalty for not enrolling in a Medicare prescription drug plan.
- Verify that all your prescriptions both brand name and generic are covered.
Step #3: Remember, you have from October 15 to December 7 to change your Medicare Advantage plan or stand-alone Medicare Part D plan to begin January 1.
- If you miss the December 7 deadline, you will have to wait until the next year’s Medicare Annual Enrollment Period (AEP).
- Medicare’s AEP is only for enrolling or changing Medicare Advantage Prescription Drug plan (MAPD) or Medicare Part D plans. You can change your Medicare supplement, long term care, or dental plans any time of year.
- Verify that your brand name and/or generic prescriptions are also in the specific MAPD or Medicare Part D formulary.
Take your time during Medicare’s AEP to explore your Medicare options. Call the Toni Says Medicare hotline at (832) 519-8664 or email firstname.lastname@example.org for assistance with Medicare issues. Toni’s books are available at www.tonisays.com with a bundle discount for Toni Says readers.