Medicare Open Enrollment Period is Right Around the Corner

The MLA is in the process of hiring a new health insurance Navigator; Alisha Keezer is no longer with the MLA. The Association will continue to have trained Navigators on staff ready to answer your health insurance questions during the upcoming enrollment period, look at plans and pricing and assist you with enrollment if you choose. Thank you for your patience during this transition.

Each year, Medicare’s open enrollment period is October 15 - December 7.

What is the Medicare Open Enrollment Period?

Medicare health and drug plans can make changes each year, things like the cost and coverage, and the providers and pharmacies in their networks. Between October 15 and December 7 Medicare recipients can change their Medicare Advantage plans or drug plans for the following year to better meet their needs.Medicare currently provides health insurance coverage for 54 million U.S. citizens. That’s approximately 1 in every 6 Americans. Medicare covers many types of services. You have options for your Medicare coverage. Medicare has four parts:Part A (Hospital Insurance) helps pay for inpatient hospital stays, skilled nursing facility care, home health care, and hospice care.Part B (Medical Insurance) helps cover medically necessary services like doctor’s visits and outpatient care. Part B also covers many preventive services (including screening tests and shots), diagnostic tests, some therapies, and durable medical equipment like wheelchairs and walkers.

Together, Part A and Part B are referred to as “Original Medicare.”Part C (Medicare Advantage [MA]) is another way to get your Medicare benefits. It combines Part A and Part B, and sometimes Part D (prescription drug coverage). MA Plans are managed by private insurance companies approved by Medicare. These plans must cover medically necessary services. However, the plans can charge different co-payments, co-insurance, or deductibles for these services than does Original Medicare.Part D (Medicare Prescription Drug Coverage) helps pay for outpatient prescription drugs. Part D may help lower your prescription drug costs and protect you against higher costs in the future.

What are Medicare Advantage plans?

Medicare Part C (MA) Plans are health plans that are approved by Medicare and run by private companies. MA Plans are offered in many areas of the country by private companies that sign a contract with Medicare. Medicare pays these private companies for their members’ expected health care.MA Plans provide Medicare-covered benefits to members through the plan, and may offer extra benefits that Original Medicare doesn’t cover, such as vision or dental services or allowances. The plans may have special rules that members need to follow, however.Part C Eligibility Requirements:You must be enrolled in Medicare Part A (Hospital Insurance)You must be enrolled in Medicare Part B (Medical Insurance)You must live in the plan’s service areaYou can’t be incarceratedYou can only belong to one plan at a time

How Medicare Advantage Plans Work in Maine

In Medicare Advantage (MA) Plans, you receive all Medicare-covered Part A (hospital Insurance) and Part B (medical Insurance) services through that plan. Many plans also include Medicare prescription drug coverage (Part D).In some plans, like Medicare Health Maintenance Organizations (HMOs), you may only be able to see certain doctors or go to certain hospitals. You pay the least money out-of-pocket when you obtain services through the plan’s network.Benefits and cost-sharing in an MA Plan may differ from Original Medicare.

Types of Medicare Advantage Plans

All Medicare Advantage Plans are similar to Original Medicare with a Supplement Plan. There are four different types of plans:Health Maintenance Organization (HMO)Preferred Provider Organization (PPO)Private Fee for Service (PFFS)Special Needs PlanYou may need to choose a Primary Care Physician and you may need referrals to see other doctors. Coverage may not extend to other areas of state or country.

What You Pay in 2018 for Medicare Part C

Each plan has a different cost structure for deductibles, copays, coinsurance and maximum out-of-pocket costs.