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What to Know About Medicare and Open Enrollment

Medicare open enrollment is now in full swing. This is the seven-week period of time each year when individuals who are eligible to receive coverage through the federal government’s healthcare program can make changes to their coverage.

Following are some commonly asked questions about Medicare and open enrollment, along with the answers to help you get the most out of Medicare if you’re eligible.

Q: Who is eligible to receive Medicare benefits?

A: All U.S. citizens who are 65 years of age and over are eligible for Medicare. Eligibility is not contingent on being retired or receiving Social Security benefits — it’s automatic once you turn 65. You also qualify for Medicare if you’re under 65 and receive Social Security Disability Insurance or have end-stage renal disease or Lou Gehrig’s disease.

If you are receiving Social Security benefits when you turn 65, you’ll automatically be enrolled in Medicare. If you aren’t receiving Social Security benefits when you turn 65, you must apply for Medicare, which you can do here.

Q: When is Medicare open enrollment?

A: This occurs from October 15 until December 7 each year. Any changes to your Medicare coverage made during this time become effective on the following January 1.

Q: When can I apply for Medicare?

A: The initial enrollment period for Medicare begins three months before you turn 65. You then have until three months after you turn 65 to complete your enrollment. If you enroll before you turn 65, coverage can start on the first day of your birthday month.

If you miss the enrollment window, you must wait until the following January 1 to apply. Coverage will then start on the following July 1.

Q: If the Medicare enrollment window is based on my 65th birthday, then what is the purpose of Medicare open enrollment?

A: Medicare open enrollment is the window during which you can make changes to your existing Medicare coverage. You have a number of different coverage options (see next question) at different price points. If your circumstances change, you might want to change your coverage.

Q: What are my Medicare coverage options?

A: There are two main coverage options: Original Medicare and Medicare Advantage. Original Medicare includes three different parts:

Part A: This covers hospitalization, skilled nursing and home healthcare, and some hospice care. You’ll pay no premiums for Medicare Part A but there are co-pays for some services and an annual deductible in 2021 of $1,484.

Part B: This covers routine visits to the doctor’s office, preventive healthcare, outpatient surgery, home healthcare and durable medical equipment. The standard monthly premium is $148.50 in 2021 — those whose annual income exceeds a certain amount face a higher premium. There’s also an annual deductible in 2021 of $203. After the deductible is covered, you’ll generally be responsible for 20% of the approved cost of care for services.

Part D: This is Medicare’s optional prescription drug coverage plan. The monthly premium for this coverage ranges from $0 to $77.10 in 2021, based on your annual income.

Medicare Advantage (MA) is offered by private insurance companies — it combines Medicare Part A and Part B, along with Part D (optionally). MA is similar to an HMO or PPO: You must choose doctors who are in network, but the costs are generally lower. There also may be coverage for extras like vision, dental and health and wellness programs.

Q: What is Medigap?

A: Also referred to as Medicare Supplemental, this is additional coverage sold by private insurers that helps pay some of the out-of-pocket expenses Medicare doesn’t cover. However, Medigap generally doesn’t cover vision, dental, long-term care, eyeglasses or hearing aids. If you choose Medicare Advantage, Medigap is unnecessary.

Q: What kind of changes can I make during Medicare open enrollment?

A: During the open enrolment period, you can switch from Original Medicare to MA or vice versa, switch from one MA plan to another, join a prescription drug plan, switch from one prescription drug plan to another, or drop your prescription drug plan. A late enrollment penalty may apply when joining a prescription drug plan for the first time.

Visit Medicare.gov for more details about Medicare benefits and eligibility. And give us a call if you have specific questions about Medicare as they relate to your situation.

 

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