What is Medicare’s annual open enrollment?
A time to review your Medicare coverage — whether you have original Medicare with prescription and supplement plans, or Medicare Advantage. During the fall enrollment period, you can sign up for new coverage or change your plan. You can switch from original Medicare to Medicare Advantage (or vice versa), add a prescription drug or supplement plan to original Medicare coverage, or choose a new Medicare Advantage plan.
Do I need to do anything during the fall enrollment period if I’m happy with my current plan?
Yes. Plans may change slightly from one year to the next, so it is important to review your coverage, even if you’re happy with it. For instance, the list of prescription medications covered by Medicare Advantage and Part D plans changes every year. Your preferred medication may no longer be covered or the cost may have changed. Also, consider how your health needs have changed: Did you start taking a new medication? Will you be traveling more? Be sure that your current plan is still the best fit.
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Medicare 101
What’s the difference between original Medicare and Medicare Advantage?
Original Medicare is managed by the federal government and offers coverage for hospital services (Part A) and outpatient services, such as primary care doctors, specialists, and routine care (Part B).
Medicare Advantage plans are run by private insurance companies approved by the federal government. These managed-care plans must cover all the same benefits as original Medicare, though you’ll be limited to their provider networks. They may offer extras, such as dental, vision, or hearing services.
Medicare Advantage plans also typically cover prescription medications. People who opt for original Medicare can buy supplemental plans to help cover more health care costs or a Part D drug plan for medications.
How do I know which plan is right for me?
It depends on your medical needs and financial resources.
Original Medicare is accepted by most doctors, which could be important if you need care while traveling out of state. Similar to many employer-based insurance plans, Medicare Advantage plans have provider networks. If you go to an out-of-network doctor or hospital, the visit may not be covered or may cost more.
Use Medicare’s online Plan Finder tool or talk to a volunteer counselor (more details on where to get help below) to decide which plan best meets your needs.
What type of plan should I choose if cost is my biggest concern?
It depends. Your total out-of-pocket expense will depend on how the plan you choose covers the services you use most. Both types of plans have a premium for Part B (doctor’s services) — about $175 a month for most people in 2024, as well as a deductible, which was $240 in 2024. CMS had not released premium and deductible amounts for 2025 at the time of publication.
Original Medicare beneficiaries pay 20% of the Medicare-approved rate for most doctor services after meeting their deductible. Supplemental plans can help cover some of these extra expenses for original Medicare members.
Copays, coinsurance, and deductibles will vary for Medicare Advantage plans, which may charge additional premiums for its prescription drug coverage and extra services.
Does Medicare restrict which doctors I can see? Can I change doctors?
Always ask before making an appointment, but most doctors accept original Medicare.
Medicare Advantage plans have more limited provider networks. Call your plan to ask for a list of in-network providers. Or ask whether a doctor you already see is in network.
You can switch doctors at any time, but make sure your new doctor is covered by your plan to avoid unexpected bills.
Are there any programs to help people pay for Medicare?
Yes. People who meet income and asset qualifications may be eligible for one of Medicare’s financial assistance programs.
*The Qualified Medicare Beneficiary program offers the highest level of assistance, helping pay for Part A and B premiums, deductibles, coinsurance, and copays for people with $1,275 or less in monthly income and no more than $9,430 in assets. Income and assets requirements may vary by state and are higher for couples.
*The Specified Low-Income Medicare Beneficiary helps people who earn too much to be eligible for the QMB program to pay for their Part B premiums.
*The Qualifying Individual program also helps cover Part B premiums, has an even higher income threshold, and is available on a first-come, first-served basis.
*The Qualified Disabled and Working Individuals program helps cover Part A premiums for people younger than 65 with a disability who are currently working.
The National Council on Aging has a website called BenefitsCheckUp to help people research these options.
Medicare open enrollment starts Oct. 15: Basic guide for your registration
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