Navigating the Medicare Open Enrollment Period: What You Need to Know

The Medicare Open Enrollment Period is a crucial time for millions of Americans who rely on Medicare to meet their healthcare needs. From October 15 to December 7, you have the opportunity to evaluate your existing Medicare coverage and make changes for the upcoming year. Whether you’re enrolled in Original Medicare, a Medicare Advantage (Part C) plan, or a Prescription Drug Plan (Part D), this period offers an opportunity to ensure your coverage aligns with your healthcare needs and financial situation.

When to Evaluate Your Coverage Options
It’s best to review your Medicare coverage annually, even if nothing has changed in terms of your health – plan benefits, costs and covered prescriptions can change every year. It’s important to revisit your Medicare choices regularly. Consider reviewing your coverage:

• If your health needs or medications have changed
• If you’ve moved, especially to a long-term care or assisted living community
• Your current plan no longer fits your budget or care needs
• You qualify for a Special Enrollment Period (retirement, losing employer coverage, or moving into a care facility)

Choosing the right Medicare plan can seem complicated, but breaking it down into key considerations can help you make an informed decision.

Understanding the Different Medicare Plans
Medicare is made up of several different parts, each providing specific types of coverage:
1. Original Medicare (Parts A and B):

• Part A covers hospital care, skilled nursing facility care, hospice care, and some home health services.
• Part B covers outpatient care, doctor’s services, preventive services, and some other healthcare services that Part A does not cover.

While Original Medicare covers a significant portion of healthcare expenses, it does not cover everything. It leaves gaps, like deductibles, co-insurance, and co-payments.
2. Medicare Advantage (Part C):

• Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans bundle Part A, Part B, and often Part D (prescription drug coverage) into one comprehensive plan.
• Medicare Advantage plans may offer additional benefits, such as vision, dental, and hearing coverage, which Original Medicare does not cover.

3. Prescription Drug Plans (Part D):

• If you’re enrolled in Original Medicare, you may need a standalone Part D plan to help cover the costs of prescription medications.
• Many Medicare Advantage plans include prescription drug coverage, so you won’t need a separate Part D plan.

4. Medicare Supplement Insurance (Medigap):

• Medigap plans are sold by private insurance companies and help pay for the out-of-pocket costs not covered by Original Medicare, such as co-payments, co-insurance, and deductibles.
• Medigap policies can’t be used with Medicare Advantage plans—they are only compatible with Original Medicare.

Key Considerations During Open Enrollment
When reviewing your Medicare options during the Open Enrollment Period, here are some key factors to consider:
1. Cost of Coverage

• Premiums: The monthly premium for your plan is one of the first things to evaluate. For Original Medicare, Part A is usually free (if you or your spouse paid Medicare taxes while working), but Part B has a premium that may vary based on income. Medicare Advantage plans may have a low or $0 monthly premium, but they could have higher co-pays or deductibles.
• Deductibles: Consider how much you will need to pay out-of-pocket before your plan starts covering costs. Some plans may have higher deductibles in exchange for lower premiums. Remember that Original Medicare does not have a limit on how much you can spend out-of-pocket each year.
• Co-pays and Co-insurance: Check the costs for doctor's visits, hospital stays, and specialist care. Some Medicare Advantage plans have predictable co-pays, while others might have a coinsurance arrangement.

2. Coverage and Benefits

• Healthcare Needs: Review your health needs and ensure that the plan you choose covers all the services you need, including any ongoing treatments, surgeries, or therapies. For example, if you have chronic conditions, you might want to make sure the plan covers specialized care.
• Prescription Drugs: Prescription drug coverage is essential for many Medicare beneficiaries. Whether you have Original Medicare with a standalone Part D plan or a Medicare Advantage plan with integrated prescription drug coverage, make sure your medications are covered. Medicare.gov offers a tool that allows you to compare drug plans to see if your medications are included on the plan’s formulary (list of covered drugs).
• Additional Benefits: Medicare Advantage plans often offer extra benefits such as dental, vision, hearing, and wellness programs. If these services are important to you, a Medicare Advantage plan might be a good option to consider.

3. Network of Providers

• Doctor and Hospital Access: If you have a specific doctor or hospital that you prefer to use, check whether they are in-network with the Medicare Advantage plan you’re considering. Unlike Original Medicare, which allows you to go to any doctor or hospital that accepts Medicare, many Medicare Advantage plans require you to use a network of doctors and hospitals.
• Specialist Care: Some Medicare Advantage plans may require referrals to see specialists, while Original Medicare generally does not. If seeing specialists freely is important to you, make sure to compare plans based on their referral requirements.

4. Plan Quality Ratings
Medicare assigns quality ratings to Medicare Advantage and Part D plans. These ratings (1 to 5 stars) are based on factors like customer satisfaction, service quality, and health outcomes. Consider selecting a plan with a higher star rating to ensure better service and outcomes.

What’s New in Medicare for 2026?

• Each year, Medicare makes updates to the available plans, coverage, and costs. For 2026, some key changes to be aware of include:
• Plan Changes: In Ohio, some plans are changing. There are some insurers who are removing plans and communicating to their enrollees that they must find a new insurer.
• Part B Premiums: The monthly premium for Part B may change slightly each year. For 2026, the standard Part B premium is projected to remain stable, but higher-income beneficiaries may pay more.
• Prescription Drug Coverage: The costs of prescription medications continue to evolve, and some plans may offer new formulary updates, meaning some drugs may move in or out of the list of covered drugs. Be sure to double-check that your medications are covered.
• Expanded Benefits: Some Medicare Advantage plans may expand additional benefits for vision, hearing, and dental services, or introduce new wellness programs and services.

How to Compare Plans
To find the best Medicare plan for you:

• 1. Visit Medicare.gov: The official website offers a comprehensive tool to compare Medicare Advantage and Prescription Drug Plans. You can enter your zip code, medications, and preferred doctors to get personalized plan recommendations.
• 2. Call 1-800-MEDICARE: If you need more help, customer service representatives can walk you through your options and help you understand what plans are available in your area.
• 3. Consult a Licensed Insurance Agent: If you’re overwhelmed by the choices or unsure which plan is best for your situation, a licensed Medicare insurance agent can assist in navigating the options and finding the right plan for your needs.

Medicare Open Enrollment is the time to review your healthcare needs and ensure that your coverage is still the best option for you. Take advantage of this opportunity to compare plans, evaluate your current coverage, and make changes if necessary. It could make a big difference in your healthcare costs and access to the services you need in the upcoming year. Make sure to take action before the December 7 deadline!

Remember, choosing a Medicare plan is a personal decision. Consider factors like cost, coverage, provider access, and any extra benefits when making your decision. And always feel free to reach out to Medicare.gov or a licensed agent to help guide you through the process.
For more information and to compare plans, visit Medicare.gov.

Source: medicare.gov and Curana Health
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This article is not a comprehensive Medicare guide. Jennings recommends that individuals visit medicare.gov or consult an insurance expert for their personalized situations.