Understanding Medicare Advantage Open Enrollment in Retirement

Medicare is such an important part of your life as you age and secure your retirement, but it’s often overlooked in retirement planning. You may have to pay IRMAA surcharges and really need to begin planning to get the most out of your benefits.

We’re happy to have had Shawn Southard on our podcast this past week to discuss Medicare Advantage Open and what it means for our listeners and clients. Shawn works in-house for us and will be helping all our clients with their Medicare needs.

Throughout the year, there are a lot of Medicare-related things that pop up that we really need to focus on. 

Note: Every month, we plan on having Shawn on the show to discuss questions that our listeners may have.

Medicare Open Enrollment Period

Medicare has quite a few enrollment periods that are easy to overlook. You can enroll when:

  • You turn 65 years old
  • You’re working past 65, retire and leave your health plan.
  • Annually, from October 15 – December 7 (this is when 95% of beneficiaries make changes to their plans)
  • January 1 – March 31st for Medicare Advantage policyholders, who can change plans or disenroll if they wish.

Medicare Advantage Open enrollment is what anyone reading this blog or who watched our episode will need to think about in January until the end of March.

What is a Medicare Advantage Plan?

Medicare Advantage plans, at a very high level, are often organized into parts by letters. But before we go into that, original Medicare is broken into:

  • Part A: Hospital coverage
  • Part B: Medical coverage
  • Part D: Prescription Drug coverage, optional but will incur lifetime penalty if not enrolled when eligible.

Part C is the Medicare Advantage plan. Medicare Advantage helps round out your Medicare. These are private plans that go through the insurance companies and are approved by Medicare. Each plan must offer the same Part A and B coverage as your original Medicare plan, but it is a private plan.

The Advantage plan offers additional benefits, such as:

  • Preventative Dental 
  • Preventative Vision
  • Hearing Exams

An Advantage plan may also combine your prescription coverage into the plan, but you’ll need to review each plan to learn more about the coverage offered.

Why Join a Medicare Advantage Plan Over Original Medicare?

A lot of you may be thinking, “Why would I switch from original Medicare to an Advantage plan?” One of the main reasons to make the switch is that original Medicare is only for things that are deemed medically necessary.

Medicare Advantage plans add in coverage for:

  • Annual physical exams
  • Dental cleanings
  • Eye exams
  • Hearing exams

Original Medicare plus a Medigap plan is an option, but this option comes with a premium that ranges from $130 – $150 per month.

Medicare Advantage has many great plans that have $0 premiums.

For a retiree, an Advantage plan often makes a lot of sense because they’re on a fixed income. 

Why Someone May Not Choose a Medicare Advantage Plan

Advantage plans seem very advantageous, but they’re also not for everyone. A downside of Medicare Advantage is that they are network plans:

  • Health Maintenance Organizations (HMOs), smaller network
  • Preferred Provider Organizations (PPOs), larger networks

You’ll need to go to someone in your network if you have an Advantage Plan. Original Medicare doesn’t have networks, so it’s easier for you to travel. You don’t need to worry about the provider being in network as long as they accept Medicare.

Medicare Advantage HMO requires you to stay in network. A PPO does have out-of-network options, but you may pay more for the services.

You need to consider the following when choosing a Medicare path (Original Medicare/Medigap or MedAdvantage):

  • Health
  • Lifestyle
  • Budget

Medicare is complex, and it’s easy to make a costly mistake along the way because of the amount of misinformation that exists. It is in your best interest to consult with a Medicare specialist before making any changes to your plan.

Why Someone May Want to Switch Medicare Advantage Plans

Since we’re in the enrollment period where someone can switch Medicare Advantage plans, the question arises: why would you switch plans?

Often, a person wants to switch Advantage plans because:

  • Doctors that they have been going to are no longer in their network, so they switch to a plan that allows them to retain the same doctor that they know and trust.
  • They plan to move and the new service area does not have their providers in network.

Shawn helps our clients choose the right plan for their medical needs and lifestyles. He has a strong educational background as a high school teacher and corporate trainer. In fact, his background as an educator is why he joined our team. He aims to educate each client, based on their individual needs, to find the best Medicare path.

Shawn needs to know your health/medical conditions, any prescription drugs you are taking, and your lifestyle (such as traveling) to help you select the right type of Medicare plan for you. 

Medicare is complex – especially if it’s not something you work with every day.

If you want to have an in-depth discussion about your Medicare situation and ensure that you’re on the right pathway, feel free to reach out to Shawn.

Click here to schedule a 15-minute call with us.