Quick tips

Tips for a better Medicare Enrollment Experience

There are two ways to get Medicare coverage

You can choose Original Medicare (Parts A & B). Part A is hospital coverage and Part B is medical coverage. Original Medicare is provided by the federal government. Benefits and coverage are the same across the country.

Or you can join a Medicare Advantage plan (Part C). Medicare Advantage plans combine Part A and Part B coverage. Many also include prescription drug coverage (Part D) and offer additional benefits. Plans are offered by private insurance companies.

You will pay a share of your costs.

Neither Original Medicare nor a Medicare Advantage plan will pay for everything.

You are responsible for monthly premiums as well as out-of-pocket costs such as deductibles, copays and coinsurance.

Protection from high out-of-pocket costs is available.

Medicare Advantage plans put a cap on your out-of-pocket costs for covered medical services. It’s called the “annual out-of-pocket maximum” and it provides built-in financial protection. Out-of-pocket costs include deductibles, copays and coinsurance for Part A and B services covered by the plan. There is no out-of pocket cap with Original Medicare.

Medicare supplement insurance plans help pay some out-of‑pocket costs not paid by Original Medicare, like deductibles and coinsurance. Plans are sold by private insurance companies.

You don’t need and can’t use a Medicare supplement insurance plan if you have a Medicare Advantage plan. The two plans do not work together.

There are two ways to get drug coverage.

You may add a standalone prescription drug plan (Part D) to Original Medicare.
Or you may enroll in a Medicare Advantage plan that includes prescription drug coverage.
Plans are offered by private insurance companies.

You may have many options.

Medicare Advantage plans and prescription drug plans vary in terms of coverage and cost. Insurance companies may offer several plans where you live.

Medicare supplement insurance plans are standardized and are the same nationwide, except in Minnesota, Wisconsin and Massachusetts.

Timing matters when you first enroll.

Your Initial Enrollment Period (IEP) is your first chance to enroll in Medicare and choose the coverage you want. Your IEP is 7 months long. It includes your birthday month or the 25th month of getting disability benefits plus the 3 months before and 3 months after. It begins and ends 1 month earlier if your birthday is on the 1st.

You are automatically enrolled in Part A and Part B if you are receiving Social Security or Railroad Retirement Board benefits when you become eligible for Medicare. Otherwise you must enroll yourself.

Medicare Part A, Part B and Part D may charge penalties if you sign up after your IEP ends, unless you qualify for a Special Enrollment Period.

It’s wise to review your choices every year.

Medicare Annual Enrollment happens each year from October 15 to December 7.
You may change your coverage choices during this time if you decide to.

You may switch from one Medicare Advantage plan or prescription drug plan to another. You may also switch from Original Medicare to a Medicare Advantage plan, or vice versa.

Changes go into effect on January 1.

You may enroll or make changes at other times.

Medicare provides Special Enrollment Periods for qualifying life events. Examples include moving your primary residence or leaving an employer health plan. Visit Medicare.gov for a complete list of qualifying events.

The Medicare Advantage Open Enrollment Period is January 1 – March 31. You may switch to a different Medicare Advantage plan or drop a plan and go back to Original Medicare at this time.