With open enrollment right around the corner (October 15th through December 7th) it is important to know your options and what may be the best one for your healthcare needs.
According to Jimmy Jenkins, Owner of J&J Medicare Solutions, and Independent Insurance Agent, “Having a good understanding of the difference between Original Medicare and Medicare Advantage is important so that you are informed when it comes to what plan you end up with after open-enrollment.”
This annual open enrollment allows for you to join, switch or leave a Medicare Advantage or Medicare Part D plan.
For those signing up for Medicare for the first time, you do not need to wait for open enrollment. Your initial enrollment period includes the three months prior to the month of your 65th Birthday, the month of your Birthday and the three months after (total of a seven-month period around your 65th Birthday).
The annual open enrollment period would only be for existing Medicare enrollees who would want to amend their current coverage. All changes would then go into effect on the first of January, following the open enrollment period.
What can you change during open enrollment?
Unfortunately, there are widespread misunderstandings of coverage that can lead beneficiaries to miss their Medicare benefits which cost beneficiaries money when they don’t understand their Medicare Options. According to a study conducted by medicareadvantage.com, close to 60% of Medicare beneficiaries don’t know when open enrollment is, and many misunderstand what their policy covers.
“Review your plans and plan coverage to make sure your doctors, hospitals and facilities are in network and make sure your prescriptions are covered,” says Jenkins. He states that working with a good local agent is important because they can help you find the best plan and offer continuity “Because good agents will be accessible for all your questions versus a call center where you are talking with someone different in most cases.”
As an independent insurance agent, Jenkins has seen his fair share of enrollees electing the wrong plan before meeting him. To avoid this Jenkins cautions beneficiaries to “NOT give your Medicare number to people that call you on the phone. With your Medicare number, your plan can be changed without you being made aware. In addition, don’t fall for the fear tactics. Calls from call centers will increase during open enrollment and often fear tactics are being used to get you to switch, even if it’s not in an enrollee’s best interest. What you may not know is agents can make money by switching you to a plan under them and obviously, they won’t make money if you don’t switch, so sometimes fear tactics are used.”
It’s also important to understand that if you elect a Medicare Advantage plan, then switching to a supplemental plan isn’t automatic. “Often times people purchase the advantage plan, thinking they can switch later to Medicare Supplement without going through underwriting but more often than not, they will need to medically qualify,” states Jenkins.
When considering your options, please make note of the definition of the following options listed on Medicare’s website (below is just a few of the many definitions offered at www.medicare.gov).
“Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).”
Did you know: Original Medicare will cover up to 100 days of care in a skilled nursing facility each benefit period.
“Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all your Part A and Part B benefits. Medicare Advantage Plans include:”
Health Maintenance Organizations
Preferred Provider Organizations
Private Fee-for Service Plans
Special Needs Plans
Medicare Medical Savings Account Plans
If you are enrolled in a Medicare Advantage Plan:
Most Medicare services are covered through the plan
Most Medicare services are not paid for by Original Medicare
Most Medicare Advantage Plans offer prescription drug coverage
“Medicare drug coverage (Part D) is an optional benefit for prescription drugs available to all people with Medicare for an additional charge. This coverage is offered by insurance companies and other private companies approved by Medicare.”
While considering your options it is important to consider the following:
With annual changes to plans and cost it is recommended that you review your options to compare rates.
Your medical situation may have changed in the past year so updating your policy can save you money.
You can switch between Original Medicare or Medicare Advantage during open enrollment.
During open enrollment you can switch to a policy that has better coverage for the medications you need so know your medications and talk to an agent on how to get them covered.
Medicare Advantage plans can become expensive if you’re sick due to copays. These plans may offer only a limited network of doctors, which can interfere with a patient’s choice so ask your agent to help identify if your physician would be covered under a new plan.
Medicare Advantage can cover some gaps of Original Medicare and usually offers a $0 premium through a private company. This may be a more affordable option for people who are not currently sick or in need of intense medical care but make note that if your medical situation gets worse, it may be difficult or expensive to switch plans.
Before switching or opting out of a plan, it is important to know what is covered under your current plan and to “truly understand how your plan works,” states Jenkins. “Having a good agent can help you with this so that you are educated and have a direct line to one person to ask questions as they arise.”
For more information about open enrollment or the Medicare Benefit, you can access the Medicare and You Handbook 2023 Here
To consult with Independent Agent, Jimmy Jenkins go to: www.jjmedicaresoluttions.com
Or call: 405.596.9172
