CATES: Medicare open enrollment

I always have the TV on in the mornings as I get ready for my day. I used to listen to the news, but found as negative as things have gotten in the world in the last few years, I do better mentally if I wait until later in the day to catch up on current events.

Instead, I have gone completely off the other end and I listen to old TV shows from the 50s on one of the nostalgia channels. In those shows, the hero always wins, good always triumphs over evil, and there are no moral dilemmas. It’s not very realistic, but it does help put me in a more positive frame of mind as I start my day. The one thing I notice on those channels is the huge volume of commercials targeted at getting people to sign up for a Medicare plan or services that give advice on choosing a Medicare plan.  In open enrollment season, those commercials make me think of an old saying, “Let the buyer beware.”

Medicare Open Enrollment for coverage in 2022 started on Oct. 15, 2021 and ends Dec. 7, 2021.  If you are age 65 or older, it’s important that you enroll for coverage during the open enrollment period. Just as important, is when you enroll, that you know exactly what you are getting from your coverage and that the coverage meets your individual needs. Not just now, but if you have a health care crisis which forces you to make major lifestyle changes, such as a fall resulting in a hip fracture, a heart attack, or a stroke. The best way to make that decision is to be informed about your options.

According to there are two types of Medicare coverage plans:  Original Medicare and Medicare Advantage Plans.

Original Medicare has two parts, part A and part B. Part A covers Inpatient hospital care, skilled nursing facility care, nursing home care that is not custodial or long-term care, hospice care and home health care.

Some things to consider with part A (hospital insurance) is that it may not cover an observation (sometimes called an “overnight” stay), and it covers 80% of costs and has a deductible, with no out-of-pocket limit.

Part B (medical insurance) covers medically necessary services by health care providers, and preventative services. Some things to consider with Part B is, again, the 80% and deductibles apply to medically necessary services, most preventative services are covered 100%.

Medigap insurance, which can be furnished by enrolling privately, or is often a part of pension plans or other retirement benefits is a good way of covering the 20% and deductible costs associated with original Medicare. Those plans can also cover observation stays and other “gaps” in Original Medicare coverage.

A Medicare Advantage Plan (also known as part C) is a plan that combines parts A and B (and sometimes part D, which I will talk about it a bit) and is administered by a private insurer.  They are the ones that are advertised in the ads on TV where an older celebrity talks about “free dental services, free rides to health care appointments” and similar benefits.

Every Medicare Advantage Plan is different, and if you decide to look at Medicare Advantage Plans, make sure you know exactly what you are getting. Some are good at limiting the up-front costs that people experience from Original Medicare, but limit services like rehabilitation and skilled nursing care when someone has a catastrophic health event where they need more time to get back to baseline. Some are the opposite, where the benefits for longer-term care are great, and the up-front benefits are less.

Medicare part D is an optional addition to Medicare which covers prescription drugs.  Like most insurers, Medicare part D works with a formulary where some drugs are covered better than others.   If you know of your specific medications, you can get a really good idea of costs and the advantages to traditional part D or a Medicare Advantage plan that includes drug coverage by looking at their formularies.

Whatever plan you choose, remember you can change it next year if needed, but generally, costs to the individual stay lowest when you enroll in one plan at age 65 and stick with it. Do your own research, don’t be swayed by a commercial or a company that has a vested interested in people picking specific plans.

The Medicare website has a great unbiased tool in helping you find the best plan for you on their website:

Your health is far too important to put your coverage to chance. Take the saying “let the buyer beware” and do your research so you find the plan that works best for you and your loved ones.