10 essential things to know about Medicare enrollment

For people turning 65, understanding the details of Medicare insurance can be complicated and the enrollment process may seem like a stressful task. While no single Medicare plan is right for everyone, understanding the available Medicare options can help you select a plan that is right for you.

What is your path to Medicare? Will you be retiring at 65? Do you plan on working past the age of 65? Are you covered under someone else’s health insurance plan? Your path will determine the decisions you need to make. There are two main ways to get Medicare coverage once Social Security administration processes your Medicare application:

1. You can choose Original Medicare (Parts A and B), which is provided by the federal government.
2. You can choose a Medicare Advantage plan (Part C), which is offered through private insurance companies.

Jeanet Reyes-Cordero, director of the Medicare solutions team at Advocate Health Care and Aurora Health Care, offers some tips for individuals to consider when thinking about Medicare:

1. With Original Medicare, you’ll pay a share of the cost

Medicare was not designed to pay all your health care costs. You will still pay a monthly premium, as well as deductibles, copays and coinsurance for services rendered.

You can purchase Medicare supplement insurance, also called a Medigap policy, from private health insurance companies. These optional Medicare supplement insurance policies may fill some or most of the expense gaps that Original Medicare Parts A and B do not cover. You can also add on optional Part D Prescription Drug coverage.

2. Medicare Advantage (Part C) is an all-in-one Medicare option.

Medicare Advantage plans offer bundled medical and prescription-drug coverage plans available through private insurance companies. You may have monthly premiums and annual out of pocket costs that vary depending on which plan you choose. With most Medicare Advantage plans, you don’t need to sign up for Part D since many plans include drug coverage. If you decide to sign up for a Medicare Advantage plan, you cannot buy or use a Medigap (Medicare Insurance supplement) policy.

3. Medicare Part D prescription drug coverage helps limit out of pocket prescription drug costs

As a Medicare member, you can obtain optional prescription drug coverage (Part D) from private insurance companies. One option is to enroll in a stand-alone Part D plan to go with your original Medicare coverage. Another option is to enroll in a Medicare Advantage plan that includes Part D prescription drug coverage bundled within the plan.

4. Know the choices in your state

Original Medicare (Parts A and B) is the same across the United States. Medicare Advantage (Part C) and prescription drug (Part D) plans offered by private insurance companies can vary by county, states and regions. Medicare supplement policies offer nationwide coverage and are available to purchase based on the state you reside in.

5. Enroll at the right time

The Initial Enrollment Period (IEP) is your first chance to enroll in Medicare. It’s the period three months before you turn age 65, the month of your birthday, and the three months after your birthday month. When you enroll will determine when your coverage begins.

6. Avoid penalties

An important tip to remember: If you don’t sign up for Part D coverage when you enroll in Medicare, you may pay a penalty if you enroll later unless you have credible prescription drug coverage. Review your plan choices annually.

After you choose your initial Medicare coverage, you can make Part C and Part D plan changes each year during the Medicare Annual Open Enrollment Period, also called the Annual Election Period (AEP), which occurs every October 15 – December 7.

It’s important to review your medical coverage annually to see if it still fits your health, wellness and budget needs.

7. Understand the Special Election Period (SEP)

In some cases, you may be able to enroll in or switch plans outside of the Initial Enrollment Period and Open Enrollment Period. This includes changes in your life situation, such as:

• You retire and leave a health care plan through your employer or union
• You move out of your current health plan’s service area

8. Review your current medical coverage just prior to becoming Medicare eligible

For example, if you have group coverage from your or your spouse’s employer, or retiree insurance from a former employer, you will want to see how your current coverage fits with Medicare.

9. Be mindful of Medicare fraud

Once you have Medicare, review your Medicare claims and Medicare summary notices on a regular basis to check for any services billed to your Medicare number you don’t recognize. If you suspect fraud, call 1-800-MEDICARE to report suspicious activity.

10. It’s important to remember help is available as Medicare can be complicated to navigate

Seek assistance from resources listed below to ensure you have the right coverage at the right time. You may even qualify for financial help.

For more information on Medicare and related services in your area:

• Register for a local in-person Medicare 101 educational seminar at one of our Advocate or Aurora locations or select a live Zoom webinar. A local state-certified SHIP (State Health Insurance Assistance Program) Medicare counselor presents at all sessions.
  • IL residents: Medicare 101 in-person seminars and Zoom webinars.
    • For additional information and resources, visit advocatehealth.com/medicare
  • WI residents: Medicare 101 in person seminars and Zoom webinars.
    • For additional information and resources, visit aurora.org/medicare
• You can also call our Medicare Solutions Team at 855-908-7910 to speak with one of our IL or WI SHIP certified Medicare counselors. You can also email your questions to the team at asc-advocatemedicare@aah.org. Please include your zip code and town of residence so we can route your message to the counselor nearest you.

Additional Resources:

Contact Medicare at medicare.gov or call 800-MEDICARE (800-633-4227) TTY/TDD 877-486-2048.