September 28, 2023 - 12:15 pm
Dear Toni: This is my first Medicare annual enrollment period, and I don’t know anything about this process. How do I find out which options are best for me? I have some health problems and I’m concerned about making a change. Which Medicare health plan and prescription drug plan do I choose? Will I have to answer health questions to qualify? — Frank, San Antonio
Dear Frank: During Medicare’s annual enrollment period, Oct. 15 to Dec. 7, the Toni Says team is asked this question at least 20 times a day.
Which Medicare option is right for you depends on your health and financial situation. You may be someone who has a history of serious health issues requiring expensive brand-name prescription drugs or who goes to the doctor once a year for a physical and takes inexpensive generics. Take your time and research your options.
Here are steps the Toni Says team uses when helping clients during the annual enrollment period:
1. Decide if you want original Medicare (Parts A and B) or a Medicare Advantage plan (Part C).
■ Ask your doctor’s office which plan is recommended. Most doctors accept original Medicare, but not all accept Medicare Advantage plans. If your doctor is in a Medicare Advantage plan’s provider directory, make sure you call to verify that the office is still accepting that specific Medicare Advantage plan.
■ The main difference between original Medicare and Medicare Advantage plans is that original Medicare works only with Medicare, and the Medicare supplement pays the deductibles or coinsurances (or you pay, if no supplemental policy is selected). Medicare Advantage plans are also called Part C. They are administered by private insurance companies that are approved by Medicare and are primarily HMO and PPO plans.
■ When choosing a Medicare Advantage plan, you must use that specific insurance company’s card, not your Medicare card.
2. Decide if you need to enroll in or change your current Medicare Part D plan during the annual enrollment period.
■ If you want Medicare prescription drug coverage to go with original Medicare, then you must enroll in a stand-alone Medicare Part D plan, which will carry a monthly premium.
■ If you choose a Medicare Advantage plan, make sure that the plan has Medicare Part D prescription drug coverage included, to keep from receiving a Medicare Part D penalty for not enrolling in a Medicare prescription drug plan.
■ Verify that all your prescriptions are covered.
3. Remember, you have from Oct. 15 to Dec. 7 to change your Medicare Advantage plan or stand-alone Medicare Part D plan to begin Jan. 1.
■ If you miss the Dec. 7 deadline, you will have to wait until next year’s enrollment period.
■ The annual period is only for enrolling or changing your Medicare Advantage prescription drug or Part D plans. You can change your Medicare supplement, long-term care or dental plans anytime of year.
Take your time during Medicare’s annual enrollment period to explore your options.
Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email firstname.lastname@example.org or call 832-519-8664.