5 must-know tips for Medicare open enrollment

By Posted : 10/08/2013

Smiling group of seniors in the parkWhile millions of uninsured Americans flock to the new health insurance marketplaces to buy coverage for 2014, Medicare beneficiaries enter their own annual open enrollment season.

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This year's open enrollment for Medicare will run from Oct. 15 to Dec. 7, 2013, and operate "business as usual," says U.S. Health and Human Services Secretary Kathleen Sebelius.

Open enrollment gives you the chance to review your Medicare coverage and, if you wish, change plans to better suit your needs. The plans you choose will take effect Jan. 1, 2014.

During open enrollment you can:

• Change from Original Medicare to a Medicare Advantage plan.

• Switch from a Medicare Advantage plan to Original Medicare

• Change Medicare Advantage plans

• Change Medicare drug plans, or drop or add a drug plan.

• Do nothing and keep your current coverage.

Here are five must-know tips:

1. Don't go to the new health insurance marketplaces.

The new marketplaces, or exchanges, open Oct. 1 for people under 65 who want to buy health insurance for 2014. You can't buy Medicare plans in the marketplaces. Medicare counts as coverage to meet the Affordable Care Act's requirement that everyone have health insurance in 2014.

2. Think about your health care needs.

Has your health changed in the last year? Are you taking new drugs? Did you receive a new diagnosis? What health care services will you likely need next year? The answers will help guide your plan choices.

3. Review your current coverage, and compare to other options.

Medical and drug plans will send "Annual Notice of Coverage" documents before open enrollment begins. Review the details. Medicare Advantage and drug plans can change from year to year, so don't assume everything stays the same. Compare your plan to others available in your area.

For a drug plan, check:

• Are your medications included in the plan's formulary?

• Can you use your pharmacy?

• Can you get drugs by mail order?

For a Medicare Advantage plan, ask:

• What does the plan cover?

• Are your doctors and hospital in the provider network?

• Will you have coverage out of state?

• Do you have to get referrals to see specialists?

Check quality ratings, available at Medicare.gov.

If you have access to other coverage, such as an employer or retiree plan, check how that health insurance coverage will work with any Medicare choices you consider.

4. Crunch the numbers.

Compare your costs for coverage, including premiums, deductibles, copayments and coinsurance.

The U.S. Department of Health and Human Services estimates the average Medicare Advantage premium for 2014 will increase by $1.64 a month to $32.60 in 2014. The number of plans available will remain about the same. Overall, Medicare Advantage premiums are down by 9.8 percent since the Affordable Care Act was passed.

Federal officials project the average monthly premium for basic Medicare prescription drug plans to stay at about $31 per month. The deductible will drop by $15 to $310.

Premiums for Original Medicare will be announced before open enrollment begins. You probably don't pay a premium for Part A, which covers hospital care, thanks to the payroll taxes you paid when working. The monthly premium for Part B is $104.90 in 2013.

5. Don't put it off until the last minute.

Give yourself plenty of time to review your options. You can get cost and coverage information about Medicare plans by visiting the Medicare.gov site or calling 1-800-MEDICARE. You can also get help by contacting your State Health Insurance Assistance Program.

If you miss the open enrollment period, your coverage will remain the same for next year, and generally you won't be able to make any changes until the next open enrollment period in fall 2014 for plans to start Jan. 1, 2015.

A quick Medicare review

There are two main ways to receive Medicare benefits - Original Medicare and Medicare Advantage. You can also buy drug plans and supplementary coverage to Original Medicare.

Original Medicare

Also called Traditional Medicare, Original Medicare is run by the federal government and includes Part A and Part B. Part A covers hospital care, and Part B covers outpatient care. You can see any doctor or visit any hospital as long as it accepts Medicare.

Medicare Advantage

These plans typically work like a health maintenance organization or preferred provider organization, and premiums are generally cheaper than premiums for Original Medicare Part B. Private companies approved by Medicare sell and run the plans. You pay more out of pocket to see doctors or use hospitals outside a plan's network. Most plans cover drugs, and some cover vision and dental care.

Drug plans

You can add a drug plan, Part D, to Original Medicare. Private companies approved by Medicare sell drug plans. You can also buy a drug plan if your Medicare Advantage plan doesn't cover drugs.


You can buy these plans to supplement Original Medicare to help pay your out-of-pocket costs. Federal law doesn't guarantee your ability to switch or buy Medigap plans during the annual open enrollment period, as it does for Medicare Advantage or drug plans. You can shop for Medigap plans at any time of the year, but the plans can reject you or charge higher premiums based on your health condition, except in limited circumstances. Companies that sell Medigap can't consider your health if you buy a plan during the first six months after you sign up for Part B of Original Medicare.

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