Medicare Open Enrollment: Everything You Need To Know

Medicare provides some of the best insurance options available to seniors. Applying for Medicare coverage can be tricky because there are multiple insurance plans available, known as parts. There are four main components to Medicare, Parts A-D. Each plan focuses on a different area, although there is some overlap with the various components. You are allowed to sign up for multiple parts to get the most comprehensive coverage, though there are a few different requirements for each part.

In addition to having multiple parts, there are also different enrollment dates for Medicare. There are standard dates, where everyone is able to apply, but there are also special enrollment periods where you can apply for coverage outside of open enrollment, but only if you meet the necessary qualifications. More information about Medicare enrollment and what each plan provides is detailed below.

Medicare Part A

Medicare Part A focuses largely on hospital insurance. This includes costs for health care in a skilled nursing facility, at home hospice care and any kind of inpatient hospital services. Medicare Part A also includes coverage for generalized health care, including annual health screenings and general doctor visits. Lab tests and surgery are also covered under this plan.

Medicare Part A is the most common form of Medicare due to the eligibility requirements. Many seniors are automatically enrolled in Part A. As long as you are at least 65 years of age, paid Medicare taxes for at least 10 years or are collecting Railroad Retirement benefits, you are automatically eligible for free Part A coverage.

Medicare Part B

Medicare Part B focuses on general medical insurance. This includes coverage for general doctor visits and other healthcare services. The costs of any durable medical equipment and home health care is also covered under Part B. Finally, you can get some preventive services covered under this insurance plan. The basic eligibility requirements are the same for Part B as Part A, but the biggest difference is you must pay for Part B coverage. Many seniors choose to combine Part A and B coverage to ensure all their medical needs are covered.

Medicare Part C

Medicare Part C offers unique coverage. Part C plans come entirely from private insurance providers. As a result, you have much more customization with Part C plans, allowing you to pick and choose the exact elements you need. For example, if you do not need hospice or nursing facility care, you can purchase a cheaper plan without these elements.

Eligibility for Part C varies depending on the insurance provider. Because Part C comes from private providers and not the federal government, the plans can greatly vary depending on where you apply. Additionally, some providers may limit coverage based on location. With larger insurance providers, you are more likely to find a universal plan.

Medicare Part D

Medicare Part D is the final Medicare plan. Like Part C, it is provided through private insurance companies. In order to get Part D coverage, you must apply for either a private Medicare prescription drug plan (PDP) or sign up for a Medicare Advantage Plan with drug coverage (MAPD). While most seniors commonly apply for Medicare Part D when they initially become eligible for Medicare, you can wait for future enrollment periods to add Part D coverage.

Unlike the other parts of Medicare, Part D focuses on one area, prescription drug costs. Each Part D plan includes a list of what drugs are covered, known as a formulary. Both generic and brand-name medications are covered in Part D. Additionally, all plans must include at least two of the most commonly prescribed categories and classes. Additionally, there must be at least two options for each prescription tier, ensuring beneficiaries have fair and reasonable access to prescription medication. The formulary may change from year to year, but your provider is required to update you on what medications are added or taken away. Eligibility for Part D is determined by the private insurer.

Base Medicare Enrollment Periods

Shortly before you turn 65, you will receive a Medicare pamphlet through the mail which details the open enrollment periods and whether you are automatically eligible for coverage. Open enrollment refers to the base period when you are allowed to apply for Medicare. Every year, open enrollment begins on October 15th and ends on December 7th. This is also the period where you make changes to your existing plans. The next enrollment period is known as the general enrollment period, which begins in January and runs until March.

Special Medicare Enrollment Periods

In addition to the base enrollment periods, there are special circumstances when you can apply for coverage. The first is if you are moving to an area where your plan no longer provides coverage, or if the area you moved has access to a better plan. If you lost insurance you received from another source, such as retiring and no longer getting employment insurance, you are eligible for the special enrollment period. Additionally, you may be able to apply for Medicare if there is a significant change in your health, such as being diagnosed with a serious condition or illness.