Understanding how Medicare works and making decisions about your Medicare coverage options can be confusing. Here are the top 10 questions Medicare beneficiaries ask Sharp HealthCare during open enrollment.
- What is open enrollment, and what can I do?
Open enrollment is the time of year when you can review your current Medicare coverage and make any changes for the following year. Medicare open enrollment begins Oct. 15, and ends Dec. 7 each year.
- If I am happy with my current Medicare coverage, do I need to do anything?
No. If you are happy with your current coverage, you do not need to do anything during open enrollment. You will remain in the same plan for the upcoming year.
- What is the cost of Medicare Part A and Medicare Part B?
You usually do not pay a monthly premium for Medicare Part A (hospital insurance) coverage if you or your spouse paid Medicare taxes while working. You pay a monthly premium for Medicare Part B (outpatient insurance), which is based on your IRS tax return from two years prior.
In addition to your monthly premium(s), Parts A and B of Medicare also have deductibles and coinsurances you are responsible for paying.
- Do Medicare Parts A and B include drug coverage?
No. Medicare Parts A and B do not include prescription drug coverage. If you would like to have prescription drug coverage, you may choose a Part D plan or a Medicare Advantage (Part C) plan that includes prescription drug coverage.
- What is a Medicare Advantage (Part C) plan?
Medicare Advantage (or Part C) plans are offered through private insurance companies and provide you with your Medicare Part A and Part B benefits. They may also include additional benefits such as drug, vision, hearing and dental coverage. These plans may offer low or $0 monthly health plan premiums beyond what you pay for Medicare Part B (outpatient insurance).
- What is a Medicare Supplement (Medigap) plan?
Medicare Supplement or Medigap insurance is a plan offered through private insurance companies that can help pay for some of the costs that Medicare Parts A and B require you to pay. This would include copayments, coinsurances and deductibles. Medicare Supplement plans enhance your Original Medicare benefits. When you have a Medicare Supplement plan, you can continue to go to any doctor or hospital that accepts Medicare. Medicare Supplement plans do not include prescription drug coverage. If you would like prescription drug coverage, you can consider purchasing a Part D plan.
- What are the differences between a Medicare Advantage plan and a Medicare Supplement plan?
The biggest differences between Medicare Advantage and Medicare Supplement plans are network and cost. Medicare Advantage plans are HMOs or PPOs where you have a network of doctors and hospitals to choose from for your care. Medicare Supplement plans allow you to go to any doctor or hospital that accepts Medicare. Medicare Advantage plans offer low or $0 monthly health plan premiums beyond what you pay for Medicare Part B. To view a list of Medicare Supplement plans and their monthly premium costs, visit the Medicare website.
- I heard there is a penalty if I have had Medicare Parts A and B, but no Part D drug coverage. Is that true?
Yes. If you have Medicare, but have not had any drug coverage and wish to enroll in a Part D plan, you may owe a late enrollment penalty. The late enrollment penalty is calculated by multiplying 1 percent of the national base premium times the number of full uncovered months you were eligible but didn’t join a Medicare prescription drug plan and went without other credible drug coverage. This penalty amount is added to your Part D plan cost and you are responsible for paying it for as long as you have drug coverage.
- What should I consider when choosing a Medicare plan during open enrollment?
When you are evaluating your coverage options during Medicare open enrollment, it is important to look at the number of times you visit the doctor in a year; the plan benefits and monthly premium; the relationship with your current doctor; hospitalization cost; whether drug coverage is included in the plan you are considering, or if you need a Part D plan and any additional services that are important to you like fitness, dental or worldwide emergency coverage.
- Do I need to enroll in the health insurance exchange, Covered California?
No. Medicare beneficiaries do not need to sign up with Covered California. If you have a Covered California plan and are turning 65 soon, it is time to switch to Medicare. If you choose not to enroll in Medicare when you turn 65, you cannot receive tax credits to help pay for a Covered California plan and you may face a late enrollment penalty if you choose to enroll in Medicare at a later date.
This story was updated in November 2018.