Medicare

Medicare Open Enrollment: Five Things You Need to Do

November 30, 2015 • By

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Last Updated: November 30, 2015

medicare 50th anniversary Routines help keep us focused, organized, and even healthy. However, if your health routine doesn’t include preparing for Medicare’s Open Enrollment, now’s the time to kick-start a new healthy habit.

If you have a Medicare health or prescription drug plan, you should review and compare coverage options. The Open Enrollment runs through December 7 and is the time you can make changes to your plan. Even if you’re happy with your current coverage, you might find a better fit for your budget or your health needs. If you miss an Open Enrollment deadline, you’ll most likely have to wait a full year before you can change your plan.

Here are five things every Medicare beneficiary can do to get in the Medicare Open Enrollment routine.

  1. Review your plan notice. Be sure to read any notices from your Medicare plan about changes for next year, especially your “Annual Notice of Change” letter. Look at your plan’s information to make sure your drugs are still covered and your doctors are still in network.
  1. Think about what matters most to you. Medicare health and drug plans change each year and so can your health needs. Do you need a new primary care doctor? Does your network include the specialist you want for an upcoming surgery? Does your current plan cover your new medications? Does another plan offer the same value at a lower cost? Take stock of your health status and determine if you need to make a change.
  1. Find out if you qualify for help paying for your Medicare. Learn about programs in your state to help with the costs of Medicare premiums, your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) deductibles, coinsurance and co-payments, and Medicare prescription drug coverage costs. Visit Medicare.gov or make an appointment with a local State Health Insurance Assistance Program (SHIP) counselor if you need help.
  1. Shop for plans that meet your needs and fit your budget. You can use the Medicare Plan Finder tool to see what other plans are offered in your area. A new plan may:
  • Cost less;
  • Cover your drugs costs; or
  • Let you use the providers you want, like your doctor or pharmacy.

If you find that your current coverage still meets your needs, then you don’t need to make any changes. Remember, during Medicare Open Enrollment, you can decide to stay in Original Medicare or join a Medicare Advantage Plan. If you’re already in a Medicare Advantage Plan, you can switch back to Original Medicare.

  1. Check your plan’s star rating before you enroll. The Medicare Plan Finder includes Star Ratings for the 2016 Medicare health and prescription drug plans. Plans are rated for quality on a one- to five-star scale: one star represents poor performance and five stars represent excellent performance. Be sure to use the ratings to compare the quality of any health and drug plans you are considering.

These are a few easy ways to get a jump-start on your Medicare Open Enrollment. For more information, call 1-800-MEDICARE (1-800-633-4227) and say “Agent.” TTY users should call 1-877-486-2048. Help is available 24 hours a day, including weekends. If you need help in a language other than English or Spanish, let the customer service representative know the language. You can also visit a local SHIP counselor. SHIP counselors provide free, one-on-one, non-biased Medicare assistance. Get free personalized health insurance counseling by calling your SHIP at the number listed on the Medicare contacts page or call 1-800-MEDICARE.

 

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About the Author

Dr. Patrick Conway, CMS Principal Deputy Administrator and Chief Medical Officer

Dr. Patrick Conway, CMS Principal Deputy Administrator and Chief Medical Officer

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Comments

  1. Connie K.

    When I enrolled for Humana Advantage Gold Plus HMO, I was aware of referrals needed for appointments to specialists. However,I was never made aware that the “specialist” would need extra referrals for everything “he/she” needed for treating my health problem! Now I could be spending a whole lot more than necessary for this misleading information and I am very upset since I’m retired…..and am stuck with this HMO for the year! It is totally unfair to the consumer and I feel there should be an exception or a 6 month enrollment period instead of 1 year!! I’m dealing with more hassles and costs than I was before.

  2. Derry W.

    I need some renewal medical packet. i did not get one this year,

    • Ann C.

      Hi, Derry. For your security, we do not have access to private information in this venue. We ask that members in our Blog community work with our offices with specific questions. You can call us at 1-800-772-1213, Monday through Friday, between 7:00 a.m. and 7:00 p.m., for assistance. Generally, you will have a shorter wait if you call later in the day. You can also contact your local Social Security office. We hope this helps.

  3. Russell G.

    I have Part A insurance but have been on my wife’s insurance so I have had credible coverage. Sh is retiring and her insurance will end May 31st. She informed them they I need something from them stating that I have been on their insurance but hasn’t gotten a date when they will give her a statement. I wanted to know what my timeline is so I can get on Part B so that I can get supplemental insurance without a penalty and be on time to not have a lapse in coverage.

    • Ann C.

      Hi, Russell. Thanks for your question. People 65 or older with coverage under a group health plan from their own or a spouse’s current employment have a special enrollment period. During this “special enrollment period”, they can enroll in Medicare Part B. This means that they may delay enrolling in Medicare Part B without having to wait for a general enrollment period and paying the 10 percent premium surcharge for late enrollment. The rules allow them to enroll under the following two situations:
       Enroll in Medicare Part B any time while they have coverage under the group health plan based on current employment; or
       Enroll in Medicare Part B during the eight-month period that begins with the month their group health coverage ends, or the month employment ends–whichever comes first.
      You will need to complete to submit Form CMS-L564 and Form CMS-40B to your local office. To avoid any lapse in coverage, you should apply at least one month in advance. We hope this helps.

  4. Steve O.

    Is there a form to fill out to disenroll in Part B Medicare

    • Ann C.

      Hi, Steve. Thanks for your comment. To terminate your enrollment, we will help you submit a signed request for termination or Form CMS-1763. The Centers for Medicare & Medicaid Services (CMS) requires, when possible, a personal interview be conducted with everyone who wishes to terminate entitlement. Therefore, we do not offer form CMS-1763 online. For an interview, you can call us at 1-800-772-1213 (TTY 1-800-325-0778) 7:00 a.m. to 7:00 p.m., Monday through Friday or go to your local office. We hope this helps.

  5. mark b.

    I signed up for medicare two days ago, and it only listed part b. i need part a also, my wife is ending my medical coverage on her companies account on April 30th, 2020. My coverage with Medicare should start on May 1st. How can I apply for part A as well?

    • Ann C.

      Hi, Mark. For your security, we do not have access to private information in this venue. We ask that members in our Blog community work with our offices with specific questions. You can call us at 1-800-772-1213, Monday through Friday, between 7:00 a.m. and 7:00 p.m., for assistance. Generally, you will have a shorter wait if you call later in the day. You can also contact your local Social Security office. We hope this helps.

  6. Patricia P.

    I need help to disenroll my Medicare benefits

    • Ann C.

      Hi, Patricia. If you wish to terminate your enrollment, a signed request for termination and a personal interview is required. You will have to go to your local office, and we will help you submit a signed request for termination. Hope this helps!

  7. Bill B.

    I just lost my Rx plan. It was through UnitedHealthcare AARP…can I get a new plan immediately or do I have to wait a full year. I take several drugs for heart and diabetes. Can I go to Aetna or some other plan without waiting?

    • Ann C.

      Hi, Bill. Unfortunately, your question is a bit more complex than we can handle in this forum. For your security, we do not have access to information about your account in this venue. To get additional information on Medicare benefits, visit here. You may also wish to contact your local Medicare SHIP (State Health Insurance Program Coordinator) to discuss your options. We hope this helps.

  8. Joni E.

    I would like to make an appointment at the Napa, CA office

    • Ann C.

      Hi, Joni. Thanks for your comment. Many of your needs can be met online by visiting our website. You can also schedule an appointment with your local office by calling us at 1-800-772-1213 between 7:00 a.m. to 7:00 p.m., Monday through Friday and a representative will assist you. We hope this helps.

  9. Lupe Q.

    I am 63 years old ,a single woman ,I am collecting Social Security Retirement ,Do I qualify for Medicare?

    • Ann C.

      Hi, Lupe. The earliest age you can get Medicare Part A and B, is 65 unless you qualify while getting Social Security disability benefits. If you are already getting Social Security retirement benefits, you will be enrolled in Medicare Parts A and B automatically. However, because you must pay a premium for Part B coverage, you have the option of turning it down. To learn more about Medicare, visit here. We hope this helps.

  10. Doreen A.

    I want to let social security know that I am turning 65 in February… I still have my husbands medical, because he is still working and we also have Tricare. How do I let them know I’m turning 65 years old next month?

    • Ann C.

      Hi, Doreen. If you are covered under a group health plan based on your husband’s current employment, you may qualify for a Special Enrollment Period (SEP) that will let you enroll in Medicare Part B. You have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
      • The month after the employment ends
      • The month after group health plan insurance based on current employment ends. Usually, you don’t pay a late enrollment penalty if you sign up during a SEP.
      You should always check with your health benefits advisor, or health plan representative to see what’s best for you. To learn more about the Medicare enrollment periods visit http://www.medicare.gov. Please call our toll-free number at 1-800-772-1213 if you need further assistance. Representatives are available Monday through Friday, between 7:00 a.m. and 7:00 p.m. We hope this helps.

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