As we reach our golden years, it’s no secret that our health becomes increasingly important. We want to be as healthy as possible for as long as possible so we can continue to enjoy all that life has to offer, be it time with our loved ones, taking part in our favorite hobby, or even picking up a new hobby. It’s never too late to become a video gamer, after all!
Along with the regular recommendations to stay healthy, like getting daily exercise and eating right, it’s also essential to have access to the medications and medical care we do and will need. That is to say that staying healthy sometimes means dealing with Medicare. Even if you aren’t currently at an age where you qualify for it yet, Medicare can be confusing and overwhelming. The same fact can be true even if you’ve been on Medicare for years, especially if you have to deal with it on your own. But here’s the thing: it doesn’t have to be, and we want you to be able to get the care you need confidently.
If you already have Medicare, then you probably already know that every year, from October 15th to December 7th is the Open Enrollment period. Chances are you’ve already seen advertisements online or elsewhere telling you about it. But here’s the exciting part-Open Enrollment means that during that period of time, you’re able to make changes to your Medicare coverage, potentially unlocking new benefits and savings. This could mean better coverage for your medications, more affordable premiums, or access to additional services. With a few potential exceptions. And don’t worry, we’ll get to all of it.
While each of us will experience life differently as we continue to age, one thing we all have in common is that we will use Medicare at some point. According to the Washington Post, as of 2020, roughly 17 percent of people in the United States were 65 or older, equalling 55.7 Million Americans. Meanwhile, it’s estimated that by 2050, that 17 percent will increase to 22 percent.
Whether you already have Medicare or are on the verge of getting it, we understand that as a senior Open Enrollment can be a stressful and confusing time. The goal of this article is to reassure you that there is support available. We’re here to guide you and help you find resources that will enable you to make informed decisions and find the best coverage for you. This way, you can live a long, happy, and healthy life.
A Bit about Medicare, and you.
We wanted to dig into Medicare a bit to help you better understand it in the hopes of making it a bit less intimidating and confusing. In a nutshell, Medicare was officially launched in 1965 and is a national program that subsidizes healthcare services for anyone 65 or older like yourself, as well as younger people with disabilities, and patients with end-stage renal disease. Medicare outright covers the cost of some of your medical needs while paying a percentage of specific costs for other needs. As a national service, Medicare is available to every American citizen aged sixty-five or older living in the United States. However, there are some exceptions to this.
If you are receiving or are eligible for the Railroad Retirement Board or Social Security Benefits or have a spouse who is living or deceased and received or qualified for RRB or SSB you qualify for will automatically be enrolled in Medicare at the age of 65. The same is true if you or your spouse worked for the government and paid Medicare taxes for an extended period.
As of the first day of the month of your sixty-fifth birthday, you will be covered by what’s known as “Original Medicare,” made up of Medicare Part A (Hospital Insurance, which covers your hospital costs) and Medicare Part B (Medical Insurance, which covers your Doctors Visits).
The three months leading up to your big birthday are when the fun really begins! To start with, if you’re automatically enrolled, you’ll receive your red, white, and blue Medicare card. If you need services like going to the doctor, simply show this card (providing your doctor accepts Medicare), and you won’t be billed. Thankfully, not having to worry about the cost of routine doctor’s visits helps to eliminate much of the stress involved in doctor visits.
In the three, you are in the initial medicare enrollment phase; during that time, you are able to choose the type of coverage you will receive. During that period, Medicare will also send you a welcome package with your official Medicare card. Even after your coverage kicks in, you will still have up to three months after your sixty-fifth birthday to lock in your selected coverage.
If you are under sixty-five years old and have a disability or ALS, you will be enrolled in “Original Medicare” automatically. Coverage starts the day that your Social Security or certain disability benefits from the RRB begin.
If you are 65 and not receiving RRB or Social Security Benefits, you would need to sign up for Medicare. You can visit https://www.ssa.gov/medicare to sign up for Original Medicare.
What Is Medicare Open Enrollment?
This brings us to Open Enrollment; as mentioned, when you originally begin your Medicare coverage, you are automatically given Original Medicare. At some point, though, you may find yourself needing more than just Medical and Health Coverage. Making changes to your coverage is perfectly normal, as people’s medical needs tend to change and evolve. The Open Enrollment Period is your chance to make changes to your converge by adding or removing services.
Specifically, you can switch your coverage from Original Medicare by adding Medicare Part D, which covers prescription drugs. During the open enrollment period, you can also add or remove Medicare Part C, aka the Medicare Advantage plan. There are a few things to keep in mind here. First, unlike Parts A, B, and D, the Medicare Advantage Plan is not part of Medicare, so you would need to speak to an outside Insurance company to obtain that coverage.
Any changes you make to your covering during the Open Enrollment Period will take place on January 1st of the following year. Suppose you happen to be enrolled in the Medicare Advantage Plan already. In that case, you have a bit more time, as your open enrollment period is between January 1st and March 31st each year. Any changes you make to the Medicare Advantage Plan during that Open Enrollment Period will take effect on the first day of the month after receiving the request.
If all of this seems confusing, that is perfectly okay! We’ll go into a bit more detail about it later, but if at any point you are confused and have questions about Medicare and your coverage, you are always welcome to call 1-800-Medicare (1-800-633-4227).
There are a few things to keep in mind during the open enrollment period as well.
First, if you are happy with your coverage, you are not obligated to change it! You can do nothing, and everything will remain the same.
What happens if I miss the Medicare Open Enrolment window?
Something important to keep in mind regarding the Open Enrollment Period is that, unfortunately, there is no grace period. Meaning that if you want to change your plan, but miss the December 7th deadline, you will have to wait until the following year to make changes to your coverage. So please take our advice and mark that date on your calendar right away! If you want to be really cautious, perhaps even set December 1st as your personal deadline. This way you can rest easy knowing that you still have time to research and make any needed changes to your coverage.
But don’t worry! There are almost always exceptions to the rules!
For example, in some situations, there are Special Enrollment Periods that will allow you to change your coverage outside of the Open Enrollment Period. Such as if you move to an address that isn’t your current plan service area, move back to the United States after living outside the country, or live in or recently moved out of a facility like a nursing home, you can change your coverage outside of the Open Enrollment Period.
You’ll also qualify for a Special Enrollment Period in the event you lose your current coverage due to losing your job, have the chance to get other coverage, or your current plan changes its contract with Medicare.
Available Government Resources
Again, it’s totally okay if you are confused by some or all of what we’ve said so far. Just take a deep breath, we’ll get through this together. Thankfully, there are plenty of official government resources to help you along the way so you can make the best choices for your healthcare needs. Just some of these resources include the following
Medicare’s Official Website, Medicare.gov
As you would imagine, the Medicare website is an absolute wealth of information. On their site, you will find extremely detailed information about Medicare, including what is and isn’t covered under Medicare. The website features a clean and easy-to-navigate design and provides links to a variety of resources on its own, including where to find drug plans and providers. You can also chat with them online for additional support. Perhaps one of the best aspects of the website is the “Medicare Plan Finder” tool that allows people to compare various plans. This tool helps to ensure that you will be able to find the ideal plan for you.
1-800-MEDICARE Hotline
As we mentioned earlier, if you prefer to talk to someone on the phone, Medicare has an additional excellent resource in their 1-800 number. The toll-free number is open twenty-four hours a day, seven days a week, except for some federal holidays. I think we can all agree that at times, hearing a friendly voice can go a long way in adding a degree of comfort when we have questions. Thankfully, those operating the phones at 1-800-Medicare have plenty of answers. Along with offering personalized help, they can answer while offering phone counseling regarding any of your questions regarding billing, claims, medical records, or expenses. Remember, help is just a phone call away, 24 hours a day.
The Medicare & You Handbook
It may shock you that another great resource regarding Medicare and Open Enrollment is probably a lot closer to you than you realize in the form of the “Medicare & You” annual handbook. If you’ve had Medicare for a while, you’ve probably had a few issues with this publication in your home. If you’ve just signed up for Medicare, you will most likely await your first copy.
This book is an excellent resource for learning about Health and drug plan options, Medicare benefits costs, rights, and protections. Its pages also contain answers to common questions.
The book is available in a physical printed version in many formats, including braille, large print, and more. It’s also available digitally, so you can access it from your laptop, tablet, or phone.
Local Assistance and Counseling
As valuable and accessible as online resources are, at times we all need a bit of one on one counseling. Speaking to someone one on one can often help overcome feelings of anxiety, or even depression that can come with making important decisions regarding Medicare’s Open Enrollment. Due to this, states offer various resources to help seniors such as yourself navigate the medicare waters.
State Health Insurance Assistance Programs (SHIPs):
The State Health Insurance Assistance Program, or SHIP, is among the best Medicare resources available for senior adults. SHIPS is a people first organization that was created to provide in-depth, objective counseling and assistance to local Medicare-eligible individuals and their caregivers. If you want to make changes to your coverage during open enrollment, one of the SHIP counselors will be able to provide personalized counseling to help you review the health or drug plan options available. They can also inform you of eligibility guidelines for coverage and answer any other questions you may have.
To find your local SHIP you can call 1-877-839-2675 or visit their website by clicking here.
Area Agencies on Aging (AAAs):
If you aren’t familiar with them, Area Agencies on Aging (AAAs) are made up of a connected group of nonprofit agencies that offer nationwide support to senior citizens and caregivers alike. Along with performing in-home assessments of your living situation and developing a plan to assist you in maintaining a comfortable quality of life, they help see if seniors such as yourself qualify for various government programs. A member of their team will be able to work with you to help build your understanding of Medicare and what your options are during the Open Enrollment period. A member of your local AAA will be able to help you find the best coverage opinion available so you can continue your life with both vigor and dignity.
If you would like to find your local Area Agency on Aging (AAA) you are welcome to use the Eldercare Locator website or call their toll free number : 1-800-677-1116
Local Libraries and Senior Centers:
There is a good chance that people within your local community have faced your challenges. As a result, they can provide a more personalized road map of your options and potential outcomes in the hopes of helping you make an informed decision regarding your coverage options.
In many cases, your local library or senior centers are also great resources to help you with any challenges you might face during the Medicare’s Open Enrollment Period. A major reason for this is that many of these places may host workshops run by volunteers who will help you better understand the options available to you when deciding your next move during the Open Enrollment Period. You will have to check your local libraries or senior centers event calendars page,
Online Tools for Research and Plan Comparison
When it comes to your healthcare, it’s always a good idea to do as much research as you can before making a final decision. Along with the previously mentioned Medicare Plan Finder tool, we found these great resources that we feel will help you make during the the open enrollment.
BenefitsCheckUp.org
The BenifetsCheckup.org website offers a free, confidential online tool that will help you quickly find programs you are eligible for and potentially save you money. Simply answer a few questions, and you’ll be on your way. One of the great things about them is they also offer online chat support and a 1-800 number in case you need additional phone counseling.
MedicareRights.org
This non-profit organization prides itself on providing comprehensive support to older Americans like you, ensuring you find lasting solutions to problems. Their website offers a wealth of information that will help you make informed decisions regarding your Medicare coverage. Along with their website, MedicareRights.org also has a 1-800 number that you can call to receive phone counseling that will help clear up any confusion you may be experiencing during the open enrollment period. Their volunteer staff are available Monday to Friday to answer any questions you may have about your coverage choices, medical bills, rights, and protections, providing you with the reassurance that you’re not alone in this process.
Websites like the ones mentioned are great research tools that help to clarify aspects of the sometimes muddy waters that make up Medicare. Remember, you have a support network and aren’t alone in this. There are people and resources available to help you navigate this process.
Medicare Plan Providers and Their Resources
Even with everything that Medicare Parts A, B, and D cover, you may find yourself wanting outside insurance. Specifically, you may find yourself wanting to sign up for Medicare Advantage. As previously mentioned in this blog, in order to get Medicare Advantage, you would need to speak with an Insurance Agent or Broker. But don’t worry! Even at this stage, there is plenty of help available.
Insurance Company Websites and Representatives
Websites such as medicare.org and cms.gov, as well as the Centers for Medicare & Medicaid Services website, contain a great deal of information that will aid you. The medicare.gov website provides tools to help you understand costs, availability, and plan options. On the cms.gov site, along with information resources, you’ll find many phone numbers that provide phone counseling. Their website also contains a helpful list of Part D Contacts for you to reach out to.
Independent Agents and Brokers:
Insurance Agents and Brokers can potentially be very helpful to work with, as they may offer options. As an elderly adult, it can feel isolating to seemingly have a lot of options when trying to decide which Medical Advantage plan would benefit you most. To that end, Brokers and Agents can offer more options and clarity than working on your own. If you are currently looking for an agent or broker, the medicarefaq.com website has a great search tool that will allow you to enter your zip code to find an agent or broker in your area. Feel free to also ask around your social circle for recommendations for Agents or Brokers they may have worked with in the past.
Conclusion
While the Medicare Open Enrollment Period can be a challenge, it’s vital to remember that you are not alone. We hope that the resources offered will make the open enrollment process easier and less frustrating for you. Our health is even more important as we get older. Thankfully, there are plenty of programs out there that can help protect your health and your wallet.
