Medicare can be confusing, but you're not alone in sorting through all the information. When you're approaching annual enrollment, your primary care provider can help connect you to a trusted partner who will guide you through the various parts of Medicare to help you better understand your options, costs and benefits.

Making an informed decision when it comes to your health coverage goes a long way in helping you to stay physically and financially well. Here are the frequently asked questions (FAQs) about Medicare’s Annual Enrollment Period (AEP).

What is Medicare?

Medicare is health insurance coverage, funded by the federal government, for people aged 65 or older or people under 65 with certain disabilities, including permanent kidney failure and amyotrophic lateral sclerosis. Medicare helps with the cost of healthcare, but it does not cover all medical expenses or the cost of most long-term care.

Original Medicare is broken down into three parts:

• Part A: Hospital insurance helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay), and some home health care and hospice care.
• Part B: Medical insurance helps pay for doctors’ services and many other medical services and supplies that the hospital insurance does not cover.
• Part D: Prescription drug coverage helps pay for prescribed medications. This coverage is optional and must be added to your Medicare plan.

Medicare also offers Part C coverage, which is known as Medicare Advantage. Medicare Advantage plans are offered by private insurance companies and typically bundle Part A, B, and sometimes D into one health insurance plan. Many Medicare Advantage plans also have additional health benefits not covered by Original Medicare such as dental, hearing or vision care.

When is the Medicare Annual Enrollment Period?

The Medicare AEP runs from Oct. 15 through Dec. 7 each year. During this period, most people on Medicare can make a change in their coverage.

During the Medicare AEP, you can change from Original Medicare to a Medicare Advantage plan. If you prefer Medicare Advantage, you can choose from the Medicare Advantage plans offered in your area during this period. If you are in Original Medicare, and want prescription drug coverage, you can choose among Medicare prescription drug plans.

What is Medicare Advantage? How does it differ from Original Medicare? 

Medicare Advantage plans, also known as Medicare Part C, are private health insurance plans approved by Medicare. All Medicare Advantage plans include Part A and Part B coverage and usually include Part D coverage for prescription drugs. Many Medicare Advantage plans also include benefits not offered by traditional Medicare, including vision, hearing, dental care, and access to wellness programs.

Medicare Advantage plans have a limit on out-of-pocket spending for services under Part A and Part B. These plans may also have lower cost-sharing than traditional Medicare, making it a more affordable option. However, Medicare Advantage coverage is limited to doctors within the plan’s network. With Original Medicare, patients can visit any doctor in the United States who accepts Medicare. Medicare Advantage plans may also have more requirements when it comes to providers because different plan types correspond to specific networks.

How can I find out if my doctor is in a Medicare Advantage plan network?

If you are looking at a specific plan or insurer, you can search for your doctor on the plan’s website. You can also contact your doctor directly. It is important to verify with your plan that your doctor is in-network.

How do I enroll in Medicare or Medicare Advantage?

If you’re signing up for Medicare Part A or Part B for the first time, you can get started at Medicare.gov. For individuals turning 65, you have three months before and three months after your 65th birthday to sign up for Medicare. The Medicare Plan Finder can help you find Medicare Advantage, Medicare Part D, or Medigap coverage depending on your individual needs.

Regardless of whether you are covered by Original Medicare or a Medicare Advantage plan, Summit Health accepts all new Medicare patients, and we look forward to welcoming you.

For more information on Medicare and what’s best for you…

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