Medicare is a government-run health insurance program that extends coverage to individuals aged 65 and older, along with younger people with special disabilities. It assists in paying for a comprehensive range of medical services, including hospital stays, doctor visits, and prescription drugs, along with post-acute care, skilled nursing facility care, home health care preventive services, and hospice care.
What Is Medicare Open Enrollment?
Every year, Medicare beneficiaries can revamp their medicare coverage during the nearly 8-week annual open enrollment period. The annual Medicare open enrollment period runs from October 15th to December 7th each year. During this time, Medicare enrollees can scrutinize the features of Medicare plans available in their area and change their medicare coverage, which takes effect on January 1st of the following year.
These changes include switching from traditional Medicare to a Medicare Advantage plan (or the other way round), switching between Medicare Advantage plans, and choosing or switching between Medicare Part D prescription drug plans.
Who Is Eligible for Medicare Open Enrollment
To participate in the Medicare Open Enrollment period, you must meet some specific eligibility criteria. These criteria ensure that only those who are currently enrolled in Medicare Part A and/or Part B can make changes to their coverage during this designated period. You must also fall under one of these categories:
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Age 65 or Older
At 65, you automatically become eligible for Medicare Part A, which covers hospital care. Medicare Part A includes inpatient stays, skilled nursing care, and essential hospital services. This grants you access to Medicare open enrollment allowing you to review your current Medicare coverage, and make changes such as switching from Original Medicare to a Medicare Advantage plan or vice versa.
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U.S. Citizen or Permanent Resident for at Least 5 Years
To be eligible for Medicare Open Enrollment, you must either be a U.S. citizen or a permanent resident who has lived in the U.S. for at least 5 years in a row. This means you are not eligible for Medicare if you are in the United States on a visa, or if you are married to a U.S. citizen or permanent legal resident, but you are not one yourself.
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Living in the United States
To participate in Medicare open enrollment and make adjustments to your Medicare coverage, you must establish permanent residency in the United States. This means maintaining a continuous stay in the United States with an intention to remain.
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Enrolled in Medicare Part A and/or Part B
During open enrollment, you can make changes to your Medicare coverage if you are enrolled in either Medicare Part A which covers hospital care, or Medicare Part B, which covers medical expenses like doctor’s visits, preventive care, and outpatient services.
How to Choose a Medicare Advantage Plan
To make an informed decision about a Medicare Advantage Plan, you can follow these steps:
- Confirm that your preferred Healthcare providers and pharmacies are included in the plan. Medicare Advantage plans have their own distinct lists of in-network providers so make sure your preferred doctors are part of the plan.
- To avoid unexpected pharmacy expenses, check if your current medications are covered under the plan and calculate the associated out-of-pocket costs.
- Understand your plan’s costs and see if they align with your budget. Consider the plan’s premiums, deductibles, copayments, and coinsurance, as these factors determine your out-of-pocket (OOP) expenses.
In Conclusion
To prevent coverage gaps, choose your new Medicare Advantage plan before the annual election period ends, usually on December 7th. This guarantees that your new coverage starts on January 1st, providing continuous protection throughout the year. Good luck!