Medicare: Open Enrollment Is Here

Medicare is one of the best insurance options for seniors because it is not only affordable, but offers extensive coverage. In some cases, you are automatically eligible for Medicare coverage when you turn 65.

Even in these situations, you may want to apply for additional coverage. Medicare is divided into four parts, A-D. There is some overlap with the plans, but for the most part, they all cover unique areas. Some plans are available through the federal government, while others come from private insurance companies.

Medicare not only has multiple parts, but there are also several enrollment periods. In addition to open and general enrollment periods, there are also special enrollment periods, where you are allowed to apply if you meet the necessary prerequisites. More information about applying for Medicare and what each plan covers is detailed below.

Medicare Part A

Medicare Part A provides coverage for hospital insurance. Some of the services covered under Part A include inpatient hospital service, nursing facilities and home hospice care. You are also covered for generalized health care, such as checkups, annual health screenings and other doctor visits. Part A also covers the costs of your lab tests or surgery. Part A coverage is provided through the federal government.

Most seniors are eligible for free Medicare Part A coverage. If you paid Medicare taxes for at least 10 years or collect Railroad Retirement benefits, you are automatically enrolled in Part A after turning 65. Several months before your 65th birthday, you will receive a Medicare pamphlet informing you whether you are automatically enrolled, as well as when your coverage begins and how to apply for other Medicare plans.

Medicare Part B

Part B is general medical insurance, such as doctor visits or consulting with a healthcare specialist. Coverage for Part B also includes costs for durable medical equipment and home health care. Preventive medical services are also covered under this plan.

Like Part A, Part B is provided through the federal government. Unlike Part A, you are required to pay a monthly premium for coverage. The basic eligibility requirements are the same for Part B. Most seniors opt for Medicare Parts A and B to get the most coverage possible.

Medicare Part C

Part C coverage is only offered through private insurance companies, not the federal government. Because the plan comes from private providers, what is covered changes depending on who you shop from. Part C plans are fairly customizable and have options from Parts A and B. The idea is, you customize your insurance plan so you only have the services relevant to your health, allowing you to cut down on costs by removing the other insurance benefits.

Eligibility changes depending on who you purchase insurance from. The number of doctors that accept Part C plans can also vary depending on where you live. Be sure to check with your current doctor to see if Part C is acceptable, otherwise, you must find a new doctor.

Medicare Part D

Medicare Part D is the most affordable insurance plan because it provides limited coverage. Part D is focused entirely on prescription drug costs. You must apply for Part D coverage through a private insurance company. Additionally, some Medicare Advantage Plans include Part D.

Every Part D plan comes with a formulary. The formulary lists what medications are covered under the insurance plan. Both generic and brand-name medications are listed on a formulary. While private companies choose what to offer with their plans, they must follow federal guidelines. The guidelines ensure all customers get access to a reasonable amount of medication. For example, their must be two options available per prescription tier, and all insurance providers must offer at least two of the most commonly prescribed categories and classes.

The formulary may change from year to year, but the insurance agency is always required to update you before an enrollment period so you know whether to continue your plan or look for a new one.

Open and General Enrollment Periods

There are multiple enrollment periods for Medicare. All of the plans use the same enrollment periods. If you already have coverage, you can apply for or remove plans during the enrollment period. Open enrollment annually begins on October 15th and goes until December 7th. The next enrollment period, known as general enrollment, begins at the start of the year and lasts until the end of March.

Special Enrollment Period

There are select circumstances where you are allowed to apply for insurance outside of the open and general enrollment periods. This is known as a special enrollment period. If you previously had insurance, such as from an employer, but lose the experience outside of a normal enrollment period, you have a small window to apply for coverage. If you experience a significant health change you may also apply for a special enrollment period to get more coverage. Special enrollment is also available if you are moving to an area where your previous insurance no longer applies.