What is Medicare open/annual enrollment?
Plus Medicare in the news and notes about Medicare Advantage
The email has been coming in fast and furious…four and five a day over the last several weeks. And those TV commercials! Plentiful all year ‘round, they’re now on steroids. You know the ones; celebrity shill familiar to baby- boomers telling us how we can get more out of Medicare.
Trouble is those are insurance-company commercials, not ads for the federal government program.
Here are two from UnitedHealthcare, the AARP®-endorsed insurance company.
Toni, Get ready for Medicare Annual Enrollment with these helpful resources
Toni, get to know Medicare before Annual Enrollment starts
The “helpful resources” include a link to an online meeting with, wait for it, an insurance sales- agent. So, no, not from the federal government program.
If you aren’t already aware of it, UnitedHealthcare and AARP® have a close relationship from which both derive lots of money. More about that in a future issue.
What is open/annual enrollment?
You’d expect this to have a straightforward answer, but you’d be wrong. Anything involving Medicare is by definition not straightforward.
According to medicare.gov, the only official Medicare website, regardless of the number of companies that have Medicare as part of their name, there are three enrollment periods, and they mean three different things.
1 - Initial Enrollment Period
This is when you first become eligible for Medicare. It begins three calander months before the month you turn 65 until three calandar months after. So, if you turn 65 on December 20, 2021 your initial enrollment period began on September 1, 2021 and ends on March 31, 2022. If you enroll in Medicare prior to your birthday your benefits start at the beginning of your birthday month i.e. December 1, 2021.
During this time, you must enroll in Medicare Part A (hospital coverage) and Part B, or a Medicare Advantage plan (formerly and sometimes still known as Part C), and a prescription drug plan (Part D) if it’s not part of the Medicare Advantage plan. You have the option of enrolling in a Medigap/Medicare supplement plan if you choose, but only along with Parts A and B.
There are exceptions.
If you’re still working or covered under a spouse’s insurance, you still have to sign up for Part A, but you can put off getting your Part B benefits. Best to check with HR to see how the individual plan works with Medicare.
Why is the Initial Enrollment Period so important? There are penalties and other cost’s associated with not enrolling during that time even if you don’t start using Medicare right away.
For example, if you enroll in original Medicare (Part A and Part B) and decide to add a Medigap/Medicare supplement plan, which is private insurance, during this period you won’t be subject to medical underwriting. But if you do so after this period you could be denied coverage completely, or be subject to medical underwriting unless you live in Connecticut, Massachusetts, Maine, or New York.
Part D (private insurance for prescription drugs) also carries a penalty for not enrolling.
Medicare.gov outlines it here.
2 - Open Enrollment Period aka Annual Enrollment Period
Every year between October 15 and December 7 you can join, switch, or drop a plan. As long as you make your request by December 7, your coverage will start January 1. For all practical purposes this means:
you can change your current plan
you can switch from traditional Medicare (Parts A and B) to a Medicare Advantage plan (private insurance that has coverage limitations) and vice versa
you can choose a different Part D (private insurance for prescription drugs) plan.
Note: the Open/Annual Enrollment period does NOT apply to Medigap insurance. You can still apply, but the protections you get when you enroll during your initial enrollment period only apply during that time.
3 - Medicare Advantage Open Enrollment Period
If you’re already enrolled in a Medicare Advantage plan (private insurance that comes with restrictions and caveats) you can switch to a different Medicare Advantage plan or switch to original Medicare and buy a separate Medicare Part D plan. This occurs from January 1 to March 31, and you can make a switch only once during each annual period.
Why aren’t the latter two folded into one? Your guess is as good as mine.
Some notes on Medicare Advantage
As you weigh your options, take a look at what Liz Weston, a personal finance columnist for the Los Angeles Times and Nerd Wallet has to say:
“Medicare Advantage plans are offered by private insurers as an all-in-one alternative to traditional Medicare, the government-administered health insurance program for people 65 and older. Medicare Advantage plans typically cover some things that Medicare does not, such as vision, dental and hearing care, but the plans also have regional networks of providers you’re expected to use. You’ll pay more, and sometimes all, of the bill if you use out-of-network providers.”
In other words, the Medicare Advantage plan is your insurance plan, NOT Medicare. You will be limited to a network of doctors, hospitals, and other healthcare-providers. Plus any medications you take and the amount you pay for them will be subject to the insurance plan’s formulary.
You can’t assume that your current doctors will be in network. Even if they do accept Medicare, they don’t necessarily accept your particular Medicare Advantage insurance or even any Medicare Advantage insurance. And you’ve got to verify this for yourself because doctors join and leave networks all the time. In addition, the directories of in-network doctors the insurer provides are not always accurate or up-to-date.
Don’t let Medicare Advantage sales agents sell you on the basis of their dental, vision, and hearing-aid coverage until you ask exactly what is included and how much you have to pay for care.
But here’s a hint: coverage is pretty spare and you have to stay within their network. And if you’re thinking well, that’s fine I can go and have that crown or inlay taken care of, think again. The dental coverage is usually limited to one or two annual exams and cleanings per year. Vision and hearing aids have similalr restrictions.
Medicare in the news
IMO it’s always a good idea to get a range of viewpoints on every issue; healthcare and health insurance are no different. So, to save you the headache of searching through thousands of websites, I’ve curated some for you. Some are behind a pay-wall…nothing I can do about that…good reporting costs money. 😉
As we’re approaching the Open/Annual Enrollment Period, these sources are about Medicare Advantage. You can also look back at Medicare’s Alphabet Soup in the archive for an overview of Medicare Advantage.
Houston Chronicle: There's a big problem with Medicare Advantage
The author, a staff writer at the Houston Chronicle provides an assessment of Medicare Advantage.
The Wall Street Journal: Most of $9.2 Billion in Questionable Medicare Payments Went to 20 Insurers, Investigators Say
The federal government’s Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) investigated payments to the private insurance companies that provide Medicare Advantage plans.
Here’s the full OIG report.
Kaiser Health News: Justice Department Targets Data Mining in Medicare Advantage Fraud Case
Kiplinger.com Medicare vs. Medicare Advantage: Ill Health Often Leads to Plan Switch
Medicare Advantage plans could be a disadvantage for people with serious health problems.
The Commonwealth Fund: Health insurance agents' lack of disclosure can affect Medicare plan choices
The Commonwealth Fund is a foundation that supports independent research into healthcare and health-policy issues.
Remember, you are your own best advocate. Gather all the information available, make sure you understand it and your options, ask lots of questions, and don’t stop until you’re satisfied you have what you need.
Thanks again for your support.
Is there something you want to see covered? Contact me at email@example.com.