Q. I have Medicare and have heard my Medicare coverage needs to be reviewed annually. Could you give me more information about this? Shelley in Conyers, GA

A. Great question!

Medicare does have an annual Medicare Open Enrollment Period for the review of your plans which will begin October 15th and end December 7th. This opportunity is given to those with Medicare to take a look at their current coverage and make any changes desired for the upcoming year. Any changes made during this period will become effective on January 1st.

With Medicare, there are basically 2 options for coverage:

1)      Original Medicare being primary. It is also recommended with this coverage that you have a Medicare Supplement and a separate Prescription Drug (Part D) plan to cover costs not covered under Original Medicare.

2)      Medicare Advantage being primary, with most including drug coverage within the plan. This is considered a “replacement” plan for Medicare. You do not lose Medicare coverage – however, the specific replacement insurance provider and type of coverage becomes your primary insurance and will set the various costs and copays, the network of providers allowed to be utilized, the coverage details for certain benefits, etc.

First, it is important to be fully aware of your specific current coverage within each of the above types. This is often best found by reviewing the insurance cards that you currently provide to your medical and pharmacy providers. With every insurance there will be a carrier (or company providing the insurance) and a specific name/type of the insurance on the front of the card. Know there are often annual changes to the Medicare Advantage and Medicare Prescription Drug plans that you currently have – so, it will be important to review any upcoming changes with your current plan providers to be aware how they might “act” in the upcoming year. For example, a drug covered in 2013 by your drug plan might not be covered by your plan in 2014. Or, a hospital that was in-network under a Medicare Advantage plan in 2013 might no longer be within the network for 2014.

Once you are aware of your current coverage and potential changes in the upcoming year, it will be important to see what options might offer increased and more financially responsible coverage for your current (and future) circumstances. During the annual open enrollment period, you have the ability to make the following changes:

  • Change from Original Medicare primary to a Medicare Advantage Plan being primary
  • Change from a Medicare Advantage Plan primary back to Original Medicare primary
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan
  • Join a Medicare Prescription Drug Plan
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