With the annual Medicare Open Enrollment upon us (October 15th – December 7th), we thought it would be helpful to highlight some key areas that you should focus on during this time to make the most of this valuable benefit.

Original Medicare or Medicare Advantage – You can change between the two (from Original Medicare to a Medicare Advantage Plan or from a Medicare Advantage Plan to Original Medicare.) However, there are a few things to keep in mind:

Changing from Original Medicare to a Medicare Advantage Plan

    1. You will want to investigate all the plans available in your area. You can visit:  www.medicare.gov .  You will enter your zip code and perhaps need to choose the county in which you live.
    2. It is easier to change from Original Medicare to a Medicare Advantage Plan than to move back to Original Medicare from a Medicare Advantage Plan because of the need for most people to purchase a Medicare Supplemental Plan to coordinate with Original Medicare. Depending on when you were first eligible for Medicare, you may have to prove insurability to purchase a Supplemental Plan.

Basics from Medicare.gov website

    1. Original Medicare:
      1. Includes Hospital (Part A) and Medical (Part B) insurance.
      2. If you want drug coverage, you can add a separate Drug plan (Part D)
      3. You can also add a Medicare Supplement Insurance (Medigap) policy to help pay your out-of-pocket costs. (Original Medicare usually pays 80% of covered expenses; you generally will need to cover the remaining 20%).
    2. Medicare Advantage Plan (most similar to an employer health plan)
      1. An all-in-one alternative to Original Medicare
      2. These “bundled” plans include Part A, Part B, and usually Part D
      3. Most plans offer extra benefits – like vision, hearing, dental and more
    3. Changing from Medicare Advantage Plan to Original Medicare
      1. If you decide that you would like to change to Original Medicare, you will need to purchase a separate Drug Plan and may choose to purchase a Medicare Supplemental Plan too
        1. Drug Plans – usually refer to Medicare Part D – You will need to have a list of all your medications, dosage, quantity and frequency for each drug, then visit medicare.gov. You can also select your preferred pharmacy.  However, you may wish to view all pharmacies in your area as another pharmacy may offer better pricing.
        2. Medicare Supplemental Plans (also called Medigap) – covers the 20% not covered under Original Medicare. There are various policies you can purchase and are referred to by a letter, such as Plan G.
          1. Note: If you currently have a Medigap Plan F, review carefully before making any changes.  This plan is no longer offered and is considered the most comprehensive plan that was available.
          2. Plans D and G with coverage starting on or after June 1, 2010, have different benefits than Plans D or G bought before June 1, 2010.
          3. Plans E, H, I, and J are no longer sold, but if you already have one, you can generally keep it. • Since January 1, 2020, Medigap plans sold to people new to Medicare aren’t allowed to cover Part B deductible.
          4. Since January 1, 2020, Medigap plans sold to people new to Medicare aren’t allowed to cover the Part B deductible. Because of this, Plans C and F are no longer available to people who were “new to Medicare” on or after January 1, 2020. – If you already have either of these two plans (or the high deductible version of Plan F) or you were covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy one of these plans.

A few notes (and mistakes) we see people make in regards to Medicare:

  • If you are married, you do not have to purchase the same plan as your spouse.
  • If you plan to move to a different area in the future, you may wish to consider Original Medicare vs a Medicare Advantage Plan. Medicare Advantage plans are offered based on your location and your current plan may not be offered in a different State.
  • If you are still working when you first become eligible for Medicare, be sure to check with your Employer’s (or your spouses’ employer) Benefits Department to verify “who pays first”. With some employer health plans, when you turn 65, Medicare pays first and your plan pays second.  You can find out more details at this website medicare.gov/basics/get-started-with-medicare/medicare-basics/working-past-65
  • If you have COBRA coverage, you will want to sign up for Medicare when you turn 65 to avoid gaps in coverage and a monthly Part B late enrollment penalty.
  • Revisit your plan choices (Original Medicare, Part D and Medicare Advantage Plans) annually

Resources to help you:

  1. medicare.gov has many helpful links and articles
  2. Your state’s local SHiP medicarehelp.org/state-health-insurance-assistance-programs-ship
    1. You even have the option to speak with someone over the phone.
  3. AARP has free webinars on a frequent basis as well as articles (you don’t have to be a member to access this information). aarp.org
  4. Your RPG Advisor – We are here to help you, so please give us a call. We would be delighted to help you make the most of this valuable benefit.
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