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Jim Jones, regional growth officer at WellMed Medical Management, North Texas

By Jim Jones, regional growth officer at WellMed Medical Management, North Texas

It’s that time of year again, when millions of Texans can select or switch their health insurance benefits for the coming year. The Medicare Annual Enrollment Period takes place Oct. 15 through Dec. 7 each year. For many older adults and caregivers, the process of choosing a Medicare plan can be challenging. Learning the lingo can go a long way in helping people navigate what can seem like a complex system.

Below are some helpful tips to guide you in the direction that best fits your needs.

Eligibility

You may be eligible for Medicare benefits if:

  • You are a US citizen 65 years of age or older.
  • You are receiving Social Security or railroad retirement benefits or have worked long enough to be eligible for those benefits but are not yet collecting them.
  • You or your spouse is a government employee or retiree who has never paid into Social Security but has paid Medicare payroll taxes while working.

Types of Coverage

You can choose Original Medicare provided by the government or add on additional benefits referred to as Medicare Advantage, or Medicare Supplement plans offered through private insurance.

Original Medicare includes:

  • Part A is hospital coverage that helps pay for hospital inpatient care, skilled nursing facilities, hospice care and home health care.
  • Part B is medical coverage that helps pay for outpatient services from doctors and other providers, preventive services and medical equipment like wheelchairs and walkers.

You can add a Medicare Advantage plan called Part C or a Medicare Supplement, also referred to as Medigap. Both plans are offered by private insurance companies approved by Medicare.

  • Medicare Advantage plans combine Part A and Part B coverage into one comprehensive plan. These plans often include prescription drug coverage (Part D) and offer benefits not provided by Original Medicare. These plans are suited for those who are generally in good health and don’t expect a great deal of medical expenses.
  • Medicare Supplement plans cover some of what Medicare Parts A and B do not cover, such as portions of coinsurance, out of pocket costs, copayments, and deductibles. These plans may be good for seniors who have significant health issues and out of pocket costs.

Enrollment period

There are several enrollment periods depending on your unique situation.

  • Initial Enrollment Period: This period starts three months before the month you turn 65 and ends three months after the month you turn 65.
  • Annual Enrollment Period: This period runs from October 15 through December 7 each year and allows you to sign up for a plan, switch plans or leave a plan.   
  • Special Enrollment Period: This period applies only to special circumstances; it allows you to make changes to your Medicare Advantage plan and prescription drug coverage when certain events happen in your life like moving or losing your coverage.
  • General Enrollment Period: This period from January to March allows you to enroll in Part A or Part B, but your coverage will not go in effect until July 1 of that same year. This period applies to individuals who forgot to enroll when first eligible or delayed enrollment for one reason or another. 

Health care coverage is an important decision for anyone, especially for Medicare beneficiaries or people new to Medicare, so educate yourself before you choose. Some questions you might want to consider include:

  • Has there been a change in providers?
  • What are the limits? What are the deductibles, copays and out-of-pocket limits?
  • Will my medication be covered?
  • How satisfied are you with your current Medicare plan?
  • Would you consider a Medicare plan more focused on prevention and wellness?

New to Medicare? Questions you should ask.

  • What are my Medicare plan options? 
  • How do I apply for Medicare Part B?
  • Am I eligible for programs that help lower prescription drug costs? 
  • Am I eligible for programs to help cover my Part B premium?
  • What resources exist to help me navigate Medicare?

Another good resource is an independent licensed insurance agent or health plan sales agent that helps Medicare beneficiaries learn about benefit options, which options will fit their needs and how they can continue to see their preferred doctors. They can also share options for coverage of special needs, such as chronic conditions or economic thresholds.

The best advice is to avoid waiting until the last minute. Start early and give yourself enough time to make the decisions that will be right for you.

For full information on enrolling in Medicare plans, review the CMS website at medicare.gov or call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours-a-day, 7 days-a-week.