Medicare Annual Enrollment Period: What You Need to Know

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 should I choose? Will I have to answer health questions to qualify?  Currently, marketing materials are bombarding me and making me even more overwhelmed. I’d really appreciate your health!

Thanks,
Frank from San Antonio, TX

Hello Frank,

The Medicare Annual Enrollment Period (AEP) runs from October 15th to December 7th. The right Medicare option depends on your health and financial situation. You may be someone who has a history of serious health issues. Or you may need expensive brand-name prescription drugs. Or you may go to the doctor once a year for a physical and take inexpensive generics. Take your time and research your options. Make sure you take your time!

Pay attention, Frank and others reading this article. I’ve got even more information for you. Below are steps my 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.

1. Ask your doctor’s office for recommendations.
   Most doctors accept Original Medicare but not all accept Medicare Advantage plans. If you have a doctor who 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.
2. Educate yourself on the differences between plans.
   Grab a pen and paper, because school is in session. The difference between Original Medicare and Medicare Advantage plans is that “Original Medicare” works ONLY with Medicare. Meanwhile, Medicare Supplement Plans pay the deductibles or coinsurances. Medicare Advantage plans are also called Part C. Administered by private insurance companies, they’re primarily HMO and PPO plans.

Step #2:  Decide if you need to enroll in or change your current Medicare Part D plan during Medicare’s Annual Enrollment Period (AEP).

1. If you want Medicare Prescription Drug coverage to go along with Original Medicare…
   Then you must enroll in a standalone Medicare Part D plan. Also, please note that there’s a monthly premium. Make sure you research what the premium is and plan accordingly.
2. If you choose a Medicare Advantage plan…
   Make sure that the plan includes Medicare Part D Prescription Drug coverage. This will prevent you from receiving a Medicare Part D penalty for not enrolling in a Medicare prescription drug plan. Trust me when I say you don’t want to pay any Medicare penalties.

Step #3:  Remember—you have from October 15th to December 7th to change your Medicare Advantage plan OR stand-alone Medicare Part D plan to begin January 1. 

1. If you miss the December 7th deadline…
   Then you’ll have to wait until next year’s Medicare Annual Enrollment Period (AEP). Please note that you may be able to enroll in a Special Enrollment Period (SEP).
2. Medicare’s AEP is only for enrolling or changing Medicare Advantage Prescription Drug plan (MAPD) or Medicare Part D plans.
   However, you can change your Medicare supplement, long-term care, or dental plans any time of year.
3. Verify that your brand name and/or generic prescriptions are also in the specific MAPD or Medicare Part D formulary.

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Turning 65 in America is a milestone and one of the markers is enrolling in Medicare. But the system is so complicated, and there is a lot of false information out there.

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