Medicare Open Enrollment runs from October 15 to December 7 this year.  If you're new to Medicare or your current plan isn't the right fit, this is the period where you'll be able to sign up for a new plan.  But it's never quite that simple, is it?  Making sense of the "Medicare Maze" of plans, coverages, premiums, co-pays, and exclusions can be overwhelming. 

However, once that enrollment window is closed, you'll be locked in to your plan for another year.  That's a long time to wait if you either can't afford it or it's not giving you the help you need!

Read on to learn a more about how to make Medicare work for you.

Medicare is a federal health insurance program eligible to US citizens 65 and older, as well younger citizens with disabilities. In order to be eligible, you must be a US resident for at least 5 years, and have paid Medicare taxes (usually deducted from your paycheck) for at least 10 years.  

Seniors have different medical needs, such as hospital procedures, doctor's visits, outpatient services, and prescriptions. There are different parts that cover each of these. Typically, seniors are enrolled in multiple parts, not just one. The plans that work best for you depend on your individual health needs and your financial situation.

There are two main Medicare plans: Part A (hospital insurance) and part B (doctor's visits and outpatient coverage).  Typically, Medicare recipients sign up for both Part A and Part B, unless they’re still working and their employer is paying for their insurance, then they’d only sign up for Part A.

Part A

Part A is free and covers 100% of your hospitalization costs after a $1,340 deductible, for the first 60 days. Then days 61-90 you have to pay $335/day. From days 91-150, you pay $670/day. And beyond that you incur all expenses.

Part B

Part B covers 80% of your doctors visits and outpatient expenses after a $183 deductible (in 2018). Part B costs $134/month.

Part C

Medicare Advantage, also called Part C is an alternative plan to Part A and Part B.  Medicare Advantage is offered by private insurance companies. It provides the same benefits as parts A and B, and has additional advantages such as co-pay for doctor's visits, sets a cap on your out-of-pocket expenses, and many plans provide prescription drug coverage.

The gaps in Medicare coverage can be significant, especially during catastrophic events that require surgery and long-term hospital stays. That’s why many seniors are benefiting from additional plans that fill the in gaps of Medicare coverage.

• Medigap covers the difference between what medicare provides and your increasing medical expenses.
• Part D (drug plans) offers coverage for prescriptions.  

It’s important to note that in order to have a supplemental or an advantage plan, you have to be enrolled in Part A and Part B.  You also might not know that if you’re not on a drug plan (Part D) you could incur significant penalty fees.

The initial enrolment period is a 7 month window. If you are turning 65 soon, or are within 90 days after your 65th birthday, you’re within the initial enrolment period and are able to choose, or switch Medicare plans.

There’s no one-size-fits-all solution; choosing the right plan requires careful consideration of your lifestyle, health, and medical needs. Medicare and supplemental plans are varied and can be difficult to interpret, often requiring an expert to help.

Susan My Insurance Lady is an Independent Insurance broker in the Wyalusing area whose only job is to find the best plan for you. The is a free service that won’t cost you a dime, but can save untold thousands in medical expenses. Call Susan to schedule a free review of your healthcare needs. Susan will shop the market to get you the most competitively priced plan available in your area.

If you’re turning 65 soon, you’ve probably received phone calls from telephone solicitors and robo-callers trying to sell medicare plans using aggressive sales tactics that pressure you into picking a plan whether or not it's the right one for you.  If you’ve been pressured into buying a Medicare plan without a thorough review, you might be on the wrong plan. Consult with Susan My Insurance Lady, your friendly local agent, to see if you’re on the right plan or if you should switch to a different one.

Can I sign up for a plan if I’m past the initial enrollment period?

If you missed the initial enrollment period (IEP) then you’ll have to wait until open enrollment between October 15th and December 7th, 2018.  Schedule an appointment with Susan to talk during this period. You can sign up for a supplemental plan (Medigap), at any time, but you’re not guaranteed to be enrolled if you’re outside of the IEP.  

Can I switch Medicare plans?

Yes. If you’re not within the Initial Enrollment Period then you can change plans, guaranteed. If you’re outside of the IEP then you can change during the Open Enrollment Period (Oct 15 - Dec 7).  You can change your supplemental plan (Part C, Part D, or Medigap) if you’re accepted.

Read on to see how Susan has helped local residents avoid huge medical expenses or avoiding overpaying for insurance coverage that won’t help them. The names and images have been changed in these stories for the protection of our clients.