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Clearing up confusion over Medicare’s enrollment period

Updated October 7, 2022 - 12:37 pm

Dear Toni: I read in your column about the upcoming Medicare Annual Enrollment period. I’m really confused. I am receiving so much mail that I am stressed about making the wrong decision and messing up my Medicare.

Is there a law that I have to change my Medicare? You helped my husband and me with our Medicare decision in January when my husband retired from his job of 30-plus years, and now it seems we have to do it all over again. Could you explain what we need to do? Thanks. — Alice from Philadelphia

Dear Alice: Stress is running rampant as the Medicare Annual Enrollment season approaches because of the economic times the country is experiencing. Many Americans are concerned that they could lose their jobs or not have enough money for retirement because of a personal health care crisis.

Good news, Alice: There is not a law that says you must make a change to your Medicare during the enrollment period (Oct. 15-Dec. 7). You do not have to change your Medicare Supplement, which the Toni Says team assisted you and your husband to enroll in. I would advise you to check your Part D plan for any significant changes. If you see a change, you can enroll in a new Medicare Part D plan to begin Jan. 1.

Below are a few tips to simplify dealing with the Medicare Annual Enrollment or, if you are new to Medicare, to make the correct choice and personalize your Medicare just for you:

Medicare Tip 1: Learn your Medicare ABCs and Ds. Part A is hospital coverage. Part B is medical/outpatient coverage such as doctor visits and surgery. Part C is Medicare Advantage Plans combining both Part A and B benefits and may include additional benefits such as vision and hearing and/or Medicare Part D coverage. Part D is for prescription drugs, with the famous “doughnut hole” coverage gap, and may be included in a Part C plan or be a stand-alone plan.

Medicare Tip 2: Know what Original Medicare covers … and what it doesn’t. Know what your Part A deductible is and that Part B Medicare pays 80 percent of approved charges while you pay 20 percent. And you have a once-a-year deductible with a monthly premium that depends upon your income.

Medicare Tip 3: Keep in mind not all Medicare plans are created equal. Medicare supplements work directly with Original Medicare, and Medicare Part C Medicare Advantage plans work differently with low or no premiums and with different out-of-pocket costs from a Medicare Supplement. Do your research especially if you have health issues and may need expensive, brand-name prescriptions.

Medicare Tip 4: Research Medicare Part D plans at every Medicare Annual Enrollment. Plans can change the covered benefits and the drug formula for the next year.

Medicare Tip 5: Don’t choose solely on price. Make sure there are not any hidden co-pays or other fees that will end up costing you money.

When someone visits the Toni Says Medicare team to personalize their Medicare situation, we tell them to forget everything they know about their old employer or individual health plans because Original Medicare is different.

Toni King is an author and columnist on Medicare and health insurance issues. For answers to Medicare questions, email info@tonisays.com or call 832-519-8664.

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