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Which Plan Is Right for Me?

Each person’s health care needs are different, but some plans may be better suited for certain individuals. While Original Medicare, Part A and Part B, is government sponsored and accepted nationwide, Medicare Advantage (MA) Plans offer additional benefits—but at a cost. Medicare Supplement (MS) Plans add coverage for certain services in addition to original coverage.

But there’s more to it than that. First let’s explain the three major types of coverage options:

Part A and Part B

This is the traditional coverage provided by the federal government when you turn 65 or qualify due to disability or End-Stage Renal Disease (ESRD). It consists of two parts: A and B. Part A is cost free and pays for hospital services. Part B—which is optional—has a premium and pays for office visits, outpatient, and some other services.

It may be a good choice for you if:

  • You can’t afford or don’t want to pay premiums. There are no premium costs for Part A. Part B premiums vary based on your income. In addition, you must meet deductibles ($1,288 for part A, $166 for part B) each year before Medicare kicks in. You’ll also have no out-of-pocket maximum to cap out your health care expenses.
  • You travel frequently. Because it is a nationally accepted program, you have access to care throughout the United States. That means you’ll pay no additional cost for going “out of network” because there is only one network: providers who accept Medicare.
  • You get coverage from an employer. If you’re still working and you get health care coverage from your employer, you may want to keep it. Purchasing an MA Plan, also called Part C, while still employed could result in you losing your employer-sponsored or retirement health coverage.

Part C

Part C Plans combine Part A and B into one product. Private insurers sell the coverage, and they may include premiums, deductibles, and copays that you’ll have to pay.

You may want to enroll in a plan if:

  • You need prescription drugs. While you can purchase Part D Prescription Drug coverage along with Part A and Part B, most MA plans include coverage for medications. Part D premiums vary depending on your income, ranging typically from $10 to $100 per year.
  • You want a cap on your out-of-pocket expenses. Like most health plans available from employers, these plans have out-of-pocket maximums. This represents the most that you’ll pay for your health care in a given plan year. Once you’ve met your out-of-pocket maximum, the plan pays for all covered services. Federal law keeps caps to no more than $6,700 per year.
  • You want more coverage flexibility. Medicare comes with a standard 20 percent coinsurance for most services, which means each time you get care, it pays 80 percent of the bill. MA Plans may offer different coinsurance amounts, like 70/30, or copays—set dollar amounts—in exchange for different premium costs. They may also include additional coverage for dental, vision, and wellness services.

Medigap

Like it says in the name, MS Plans—also called “Medigap”—are in addition to Part A and Part B. Rather than choosing a plan with a private insurer, you may want to purchase an MS Plan along with enrolling in Part A and B.

It is offered by private insurance companies in plan types designated A through N. The federal government sets the benefits for these plans, each with varying degrees of coverage. The only difference among insurance companies is price and reputation.

The main reason why you might choose this route is that you like Part A and Part B, but want additional coverage. You may be generally happy with the cost and access that come with traditional coverage, but want more. MS Plans cover services not covered such as dental, vision, hearing aids, and private or long-term care.

So how do you choose which one is right for you?

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A How-To Guide To Change Your Medicare Plan This Year

Open Enrollment for Medicare is October 15 through December 7 each year. During Open Enrollment, you can make changes to your Medicare plans to help you get better coverage, save money, or consolidate your premiums. These changes include switching between Original Medicare and a Medicare Advantage (MA) plan, sometimes called Part C, switching from one MA plan to another, and adjusting Part D prescription drug coverage.

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What is the Annual Enrollment Period?

The Medicare Advantage and Prescription Drug Plan Annual Enrollment period, is a period each year from October 15 through December 7, during which you can make changes to your coverage or enroll in a plan if you haven’t yet done so. Apart from special circumstances like moves or loss of employer coverage, this is the main time each year you can make changes to your coverage. As such, it’s important to take advantage of it.

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What changes can I make during the Annual Enrollment Period?

During Annual Enrollment you can do the following to change Medicare plans:

● Switch between Original Medicare and an MA plan
● Switch from one MA plan to another
● Drop or join a Part D Prescription Drug Plan (PDP)
● Switch from one PDP to another

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How do I switch from Part A and Part B to an MA plan?

If you currently have Original Medicare—Part A and Part B—and you’d like to consolidate your coverage with an MA plan, you can do so during Open Enrollment. Before you enroll in a plan, you’ll want to compare the plans available in your area. Not all MA plans work the same or offer the same coverage.

Once you’ve decided on a plan, all you need is your Medicare number and the date your coverage started, both of which can be found on your Medicare card. There are a few different ways to enroll:

● Use the Medicare Plan Finder and follow the subsequent instructions.
● Enroll on your plan’s website.
● Fill out a paper form (which you can get by contacting the plan you’re interested in).
● Call the plan and enroll over the phone.
● Contact Medicare at 1-800-433-4227, (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov

Once you enroll in a plan, your Part A and Part B coverage will be replaced by the MA plan. You don’t have to worry about making any changes on that end.

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How do I switch to a different MA plan?

If you’ve found an MA plan you like better than your current plan, switching is easy. Simply enroll in the new plan using one of the methods above during the Open Enrollment Period, and that’s it. You’ll be automatically removed from your old plan once the new coverage begins.

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How do I switch from my MA plan back to Original Medicare?

If you decide you prefer the flexibility of Original Medicare, you may be eligible to switch back during the Open Enrollment Period, from January 1- March 31. You’ll have to either contact your current MA plan or call Medicare at 1-800-433-4227, (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week, and let them know you want to switch back. They’ll take it from there.

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How do I join a Part D plan?

If you need prescription drug coverage, you can sign up for a Part D plan during the Annual Enrollment Period. When signing up for a PDP, it’s important to remember that not all plans will cover all prescription drugs.

Each plan has its own list of covered drugs, called a formulary, so before signing up for any plan, you’ll want to review that plan’s formulary and make sure the prescriptions you take are covered. You can contact the plan you’re interested in to verify this.

Once you’ve picked a plan, you can sign up using the following methods:

● Use the Medicare Plan Finder.
● Enroll on the plan’s website.
● Fill out a paper form.
● Call the plan.
● Call Medicare at 1-800-433-4227,(TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov

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Can I drop my prescription drug coverage?

If you no longer want or need prescription drug coverage, you can drop your current plan without enrolling in a new one during the next Annual Enrollment Period. There are several ways you can drop your plan:

● Call Medicare at 1-800-433-4227, (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov
● Send a signed written notice to the plan that says you want to disenroll.
● Submit a request on the plan’s website.
● Call the plan and request a disenrollment notice that you then fill out, sign, and mail back.

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How can I switch to a new Part D plan?

If you’re not satisfied with your current PDP, you can switch to a new one during the Annual Enrollment Period. All you need to do is join a new plan using one of the methods above—the old plan will be canceled automatically when your new coverage starts.

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Can I change Medigap plans during Annual Enrollment Period?

Medicare Supplement (MS) insurance, also known as Medigap, helps pay some of the health care costs not covered by Part A or Part B. MS policies are offered by private insurers, and they do not follow the standard Annual Enrollment Period rules.

The MS enrollment begins when you first enroll in Part B after you’ve turned 65 (Part B is required to be eligible for Medigap). When you enroll in Part B, you have six months to enroll in an MS policy. After those six months, you can still consider changing Medicare Supplement plans, but you’ll be subject to the rules of the private insurer offering the policy. An insurer may, for example, deny you coverage based on pre-existing medical conditions.

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Are there any other times I can change Medicare plans?

Following certain life circumstances, you may be allowed a Special Enrollment Period (SEP) that lets you make changes to your Medicare coverage. There are a variety of situations that can cause an SEP:

● You move to a new address that falls outside your current plan’s coverage area
● You move to a new address that adds additional plan options
● You move back to the US from another country
● You lose Medicaid eligibility
● You disenroll from employer-provided health coverage
● You become eligible for insurance offered by your employer
● Medicare terminates your plan’s contract

The time frame for Special Enrollment Periods varies for each situation that arises, so if you become eligible for an SEP, make sure you act quickly. You can also consult the full list of circumstances and the duration of each enrollment period at Medicare.gov.

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Is there anything new for 2020?

There are some changes to Medicare for 2020 that you should be aware of as you consider your coverage options:

● Part D standard benefit deductible amounts have increased for 2020
● Part B premiums may increase for beneficiaries in higher tax brackets.

Always make sure to check your Annual Notice of Change to see if your plans or coverage are changing.

Since the Annual Enrollment Period is only for a limited time each year, it’s best to have some idea of what changes you want to make going into it. This ensures you have time to get everything sorted out so the process can go as smoothly as possible.

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