By Insure.com – Last updated: July 11, 2017
Open enrollment for Medicare runs from Oct. 15, 2017 to Dec. 7, 2017 for plans starting Jan. 1, 2018.
While the future of the private health insurance market continues to be uncertain, Medicare open enrollment is running like it has for years.
As a Medicare beneficiary, you have from Oct. 15, 2017 to Dec. 7, 2017, to review your coverage and make any changes for 2018. New coverage for changes made during the open enrollment begins January 1, 2018.
The state and federally run ACA marketplaces (exchanges) for individual health insurance plans, begin open enrollment two weeks after Medicare open enrollment begins and runs until Dec. 15. The coinciding events are confusing to some people, but Medicare’s open enrollment is not a part of the Marketplace.
Some seniors mistakenly think they can enroll in a Medicare plan through ACA health insurance marketplaces. But while the marketplaces will sell private individual health plans to people under age 65, they don’t sell Medicare plans. People with Medicare do not need to enroll in the health insurance marketplaces.
Medicare’s open enrollment period is the time when participants should review their current health and drug plans and decide if any changes should be made.
Medicare open enrollment options
During the Medicare open enrollment period you can:
- Do nothing and keep your current Medicare medical and drug coverage as is.
- Switch to a Medicare Advantage plan from Original Medicare.
- Switch to Original Medicare from a Medicare Advantage plan.
- Change Medicare Advantage plans.
- Change Part D prescription drug plans, sign up for a drug planif you don’t have one now, or drop drug coverage.
Over 65 percent of the plans have a quality rating of four or more stars, based on a five-star rating.
Just turning age 65?
You have three months before your birth month and three months after your birth month to enroll in Medicare. If you turn 65 this fall, you’ll need to enroll for coverage to take you through the end of this year and sign up for coverage for 2018.
If you have an ACA Marketplace, workplace or individual health insurance policy, you can keep it until your Medicare coverage begins. Once your Medicare starts up, you can cancel your Marketplace or private health insurance policy without penalty. If you’re continuing to work and receive group health insurance from your employer, you may be able to delay signing up for Medicare Part B (without penalties) until your employment terminates. Discuss with your employer your healthcare coverage, if this situation applies.
Review your annual Medicare changes
Reviewing your coverage is important because Medicare Advantage and drug plans can change, and so can your health care needs.
You should receive an “Annual Notice of Change” from your plans before open enrollment begins. Review the information to understand Medicare coverage and costs for next year. Among the questions to ask:
- Does the prescription drug plan cover the medications you take? What are the coverage rules for drugs? Can you use your pharmacy or get mail-order prescriptions?
- Are your doctors and hospital in the health plan’s network? Do you need to get referrals to see specialists?
- How much will you pay in premiums and out-of-pocket health care costs, such as deductibles, copayments and coinsurance?
- What is the plan’s quality rating?
- Will you have coverage when you’re out of state or the country?
- Do you have access to other coverage, such as group health through a current or former employer? How will Medicare work with that insurance?
Two main ways to buy Medicare plans
The federal government runs Original Medicare, which includes Part A and Part B. Part A covers hospital care, and Part B covers doctor visits, outpatient care, lab work, X-rays and preventive services. You likely don’t pay a premium for Part A coverage if you and your spouse paid Medicare taxes while working. You do have to pay a deductible, however, before hospital coverage kicks in. You pay a monthly premium for Part B, as well as a deductible and coinsurance.
With Original Medicare you can see any doctor or go to any hospital that accepts Medicare.
You can add a prescription drug plan — Part D. Private insurers sell drug plans, which are approved by Medicare. You pay a monthly premium for a drug plan.
In addition you can buy a supplemental plan, called Medigap, to help cover some of your out-of-pocket costs. Private companies sell Medigap plans, which are standardized by letters A through N in most states.
You don’t have a guaranteed right to buy or switch Medigap plans during the annual Medicare open enrollment period in the fall. The best time to buy a Medigap plan is during the first six months you’re at least 65 and enrolled in Plan B. During this period, federal law gives you the right to buy a plan, regardless of your health condition. You can still buy or switch Medigap plans later, but except in limited situations Medigap plans can turn you down or charge you higher premiums based on your health. The Affordable Care Act provision prohibiting insurers from rejecting or charging higher premiums for people with health conditions does not apply to Medigap because the stipulation is only for those under age 65.
Private companies approved by Medicare sell Medicare Advantage Plans. These plans usually operate like health maintenance organizations or preferred provider organizations. You must use doctors or hospitals in the plan’s network, or you pay more out of pocket for care. Medicare Advantage plans combine Part A and Part B of Original Medicare, and most cover prescription drugs. Some plans also cover vision and dental care. You pay a monthly premium as well as copayments or coinsurance.
You can add a drug plan to a Medicare Advantage plan that doesn’t cover medication. You cannot buy a Medigap plan if you have Medicare Advantage.
Since Congress passed the Affordable Care Act, average Medicare Advantage premiums went down by 10 percent from 2010 to 2016, according to the U.S. Department of Health and Human Services.
The following prices are for the 2017 coverage year and will be updated once the 2018 information becomes available:
Part A – Most beneficiaries of Medicare don’t pay a monthly premium for Part A. However, if you’re not eligible for premium-free coverage, you’ll pay $413 for Part A. The deductible is $1,316 for each benefit period. (A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility (SNF). The benefit period ends when you have not received any inpatient hospital or SNF for 60 days in a row.)
Part B – The average premium for Part B is $109 for most people receiving social security benefits.
Part C – Around 30 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans, according to Kaiser Family Foundation. The monthly premium average cost is $36 a month; however, premiums paid vary greatly. Those in a HMO average around $28 a month and local PPO enrollees pay on average $55 a month.
Part D (drug plan) – Most Medicare drug plans charge a monthly fee that varies by plan. The average monthly premium for basic Medicare prescription drug plans is about $34 per month. Deductibles vary, but no Medicare drug plan may have a deductible more than $400.
The so-called “doughnut hole” starts at a higher limit this year. The doughnut hole is the coverage gap between the limit on initial coverage for drugs and the spending threshold when catastrophic coverage for drugs begins. During this time, beneficiaries pay a larger part of the total costs of drugs. In 2017, your initial coverage limit is $3,700.
Catastrophic coverage will kick in once you’ve spent $4,950 out of pocket on drugs for the year, up $100 from 2016. Catastrophic coverage makes it possible for you to pay a small coinsurance amount or copayment for covered drugs (5 percent of the cost of drugs) for the rest of the year. The coverage gap will close in 2020.
Where to get help
Visit Medicare.gov to get information about plans in your area or call 1-800-MEDICARE. You can also get help by contacting your State Health Insurance Assistance Program. The “Medicare & You” booklet is available for download on the Medicare website.
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