Here is Everything you need to know to climb up the Medicare learning curve.
What does the term “learning curve” mean?
It means a way of learning that lets you gradually learn what you need to know about a topic before you jump in.
The learning curve concept is useful when you are preparing to handle a lot of different tasks. Whether you want to do stand-up comedy, become a mixed martial artist, be a matador, or a brain surgeon, you don’t just jump in and hope for the best. You need training.
The same is true for enrolling in Medicare, but you tend to feel that you are expected to make the right decisions right away, without much prior knowledge or experience. (“Get online, check some boxes, it will only take 10 minutes.”) It is hardly any wonder you will feel unprepared, pressured, and stressed.
And – this is even worse – you are probably going to make mistakes that will cost you money. And you could sign up for coverage that doesn’t cover your basic needs.
But don’t worry! The purpose of this article is to move you up the Medicare learning curve right away, so you will get the coverage you need without going through a costly process of trial and error.
Let’s get going by providing answers to the questions you need to understand.
When Can You Enroll in Medicare?
Okay, put on your hiking boots, because we are going to start with a quick scramble up one of the most confusing topics about Medicare.
Chances are you will enroll in Medicare at the same time you sign up for Social Security. That’s great, and it makes everything seem easy. But even if you enroll in Medicare then, things become more complicated. What if you want to enroll not only in Original Medicare but want to buy a Medicare Advantage or Supplement Plan? What if you are already enrolled in a Medicare Supplement of Advantage plan but want to pick a different one?
In cases like those, things can become complicated. But don’t sweat it because you can switch and/or buy a new plan at different times during the year.
You can enroll in Medicare during one of these periods:
- Initial Enrollment Period – Most people can first enroll in Medicare (Part A, B, C, and D) during a 7-month window: 3 months before the month they turn 65, the month they turn 65, and in the three months after the month they turn 65.
- Medicare Part C & D Annual Enrollment Period (AEP) – Between October 15 and December 7 every year, existing Medicare beneficiaries can use this period to re-evaluate and make changes to their Medicare Advantage (Part C) and Medicare prescription drug plans (Part D). They cannot use AEP to enroll in Part A and/or Part B for the first time. If you enroll in a plan during AEP, coverage starts on January 1 of the following year.
- Special Enrollment Period (SEP) – You may qualify for a special period to enroll in Medicare based on certain life events such as if you change your residence or you’re your current coverage. Depending on your circumstances, you generally will have two full months to enroll.
- Medicare General Enrollment Period (GEP) – January 1 to March 31, every year. Most people will enroll in Medicare Part B coverage when they first sign up for Medicare. The GEP is reserved for individuals who chose not to enroll in Part B when they were first eligible. Beginning 2023, Coverage starts the 1st of the month after you apply.
- Medicare Advantage Open Enrollment Period (MA-OEP) – January 1 to March 31, every year. MA-OEP is only for people who are enrolled in a Medicare Advantage plan as of January 1. During MA-OEP, you can switch to a different Medicare Advantage plan with or without drug coverage or switch back to Original Medicare and also join a standalone Medicare Prescription Drug plan. You cannot switch from Original Medicare to a Medicare Advantage plan during this period.
What Should You Consider Before Choosing a Medicare Plan?
- Doctor coverage – You need to find a plan that covers the doctors and other care providers you already use – or would like to use.
- Medicare prescription drug coverage – Consider whether a plan has prescription drug coverage and whether the medications you take are included in that plan’s list of covered drugs. This differs from plan to plan, so it’s essential to be sure the plan covers your prescription drugs.
- Total out-of-pocket costs – In addition to your monthly premium, you should also evaluate other out-of-pocket costs like the deductibles, copays, coinsurance, and maximum out-of-pocket amounts before selecting your health insurance plan.
- Additional benefits – Many Medicare Advantage plans offer additional benefits for their members that are not covered by Original Medicare (see the next section below). For example, some Medicare Advantage plans include free memberships to gyms. Other plans provide services such as telehealth doctor visits, physical therapy, or chiropractic care. Don’t assume that the extras you want will be covered. Ask ahead of time.
What Is Original or Traditional Medicare (Medicare Parts A and B)?
Medicare is a federal program that delivers health insurance for U.S. citizens (and permanent residents with more than five years of continuous residency) who are age 65 and older, as well as individuals with certain illnesses or disabilities. Most people first get Medicare when they sign up for Social Security benefits.
Original (or ‘Traditional’) Medicare provided by the government helps to cover the costs of hospitalization services (that’s Medicare Part A) and physician services (that’s Medicare Part B). Original Medicare does not cover prescription drugs (otherwise known as part D, see below) or other medical services. While Original Medicare will help pay costs for your care, you are responsible for paying premiums, deductibles, copayments, or coinsurance costs.
What is a Medicare Advantage (Part C) Plan?
Medicare Advantage (also known as Medicare Part C) is Medicare coverage that is provided by private insurance companies contracted with Medicare. Medicare Part C is an all-in-one “bundled” alternative to Original Medicare and covers everything that Original Medicare (Parts A and B) does and often includes extra benefits as well such as prescription drugs coverage as well as extras like dental, vision, and hearing care.
What is a Prescription Drug Plan (Part D)?
Medicare Part D plans provide prescription drug coverage. They are standalone prescription drug insurance policies provided by private insurance companies. Because original Medicare does not cover prescription drugs, purchasing a PDP policy can help you lower your prescription drug costs.
You can also receive Part D coverage if you enroll in a Medicare Advantage plan which includes Part D. An all-in-one “bundled” alternative to Original Medicare covers everything that Original Medicare (Parts A and B) covers and often includes extra benefits as well as prescription drug coverage, dental, vision and hearing care.
What is a Medigap (or “Medicare Supplement”) Plan?
Medigap plans are a form of insurance that helps to cover the gaps in Original Medicare. In other words, Medigap plans help to pay for out-of-pocket costs such as deductibles, copays, and coinsurance that you are responsible for under Original Medicare. Medigap can only be used in combination with an Original Medicare plan and does not cover prescription drug costs (Part D) or any extra benefits.
There are 10 different standardized kinds of Medigap plans (A, B, C, D, F, G, K, L, M, and N) to choose from, depending on your needs and budget. The two most popular Medigap plans are Medicare Supplement Plan G and Plan N. You don’t need to explore these differences now – when you speak with a Medicare advisor, he or she will dig in and help you select the plan that will work best for you.
What Are Your Next Steps to Enroll?
Speak with a CoverRight Medicare Advisor to discuss your options. What will you discuss in this call? A recent post on the CoverRight Blog explains it all!
You will discuss your health concerns, check to see whether you can continue to visit preferred physicians and care providers in different plans. Your Medicare Advisor will also check to see whether your prescription drugs will be paid under different plans that are available to you.
In only 30 minutes, you will have a list of plans that meet your needs. You will not only have climbed the learning curve, but you will also have conquered it. And there is absolutely no charge to you for the call.
Why not schedule a call with a CoverRight Medicare Advisor today?
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CoverRight is on a mission to make the Medicare plan selection process easy to understand. We are here to help you compare Medicare plans and find the one best suited to your specific situation. Try the platform for yourself.
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