It’s that time of year again when millions of Americans across the country have the opportunity to select or switch their health insurance benefits for the coming year. The Medicare Annual Enrollment Period takes place October 15th through December 7th. For many Medicare-eligible adults and caregivers, the process of choosing a Medicare plan can be challenging. Learning the lingo can help guide you in the right direction.

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 choose a plan with additional benefits referred to as Medicare Advantage or Medicare Supplement plans offered through private insurance companies.

Original Medicare includes:

• Part A is hospital coverage that helps pay for hospital inpatient care, skilled nursing facilities, hospice care, and home healthcare.
• 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 also choose 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 15th through December 7th 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 into effect until July 1st of that same year. This period applies to individuals who forgot to enroll when first eligible or delayed enrollment for one reason or another.

Healthcare coverage is an important decision, so educate yourself before you choose. You can visit the Center for Medicare & Medicaid Services website at www.medicare.gov or call 1-800-MEDICARE. TTY users should call 1-877-486-2048 (available 24/7) or contact Medicare Advantage health plans that interest them directly. You can learn which Medicare plans Atrius Health accepts here.

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