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Medicare Open Enrollment: Which Plan is Right For You?

Mar 12, 2008
It's February again, and the millions of Americans who are currently on Medicare know what this season means: the time for open enrollment is quickly running out.

Starting each year on November 15 and running through March 31, open enrollment gives individuals currently on Medicare the opportunity to change their Medicare coverage to either Original Medicare or to a private Medicare Advantage health plan.

But what does open enrollment really mean to you, and what are the advantages and disadvantages of each option?

What is Open Enrollment?
The Centers for Medicare & Medicaid Services (CMS) announces an Open Enrollment Period each fall. Open Enrollment simply allows you to make changes to your Medicare plan - or not.

"Now is the time for Medicare beneficiaries to carefully review their current plan to see how changes may affect their costs and coverage - and then compare their plan to other options available to them," says Health and Human Services Secretary Mike Leavitt. "If they are satisfied their plan will meet their needs next year, they do not need to take any action to keep their coverage."

Simply put, this means that if you are happy with your current coverage and you don't want or need to make any changes, you don't have to do anything at all - your coverage will continue as long as you continue to qualify for your benefits.

But what if you feel that you would like to explore your options? What are the differences between Original and Advantage?

Original Medicare
The health insurance program run by the federal government, Original Medicare is made up of two parts, Part A (inpatient, or hospital benefits) and Part B (outpatient coverage). To date, most individuals on Medicare opt to stay with Original Medicare, which offers access to virtually all doctors, specialists, and hospitals in the country.

However, if you do choose to remain with Original Medicare you may want to consider purchasing supplemental health insurance to cover the cost of procedures and care not covered by Original Medicare.

You may also wish to consider enrolling in a private drug plan, or PDP, to assist with prescription drug costs. These types of plans work with Medicare Part D, introduced in January 2006. Part D provides drug and prescription coverage not previously available in Original Medicare. Note that special eligibility requirements exist for enrollment in Part D.

Medicare Advantage
Medicare private health plans - commonly provided through private insurance companies - offer low premiums and other special benefits. Insurance companies offering Medicare Advantage plans are required to cover the same hospital and outpatient services offered through Original Medicare.

Although Medicare Advantage plans often offer many special benefits not covered by Original Medicare - such as dental and vision care - it is important to keep in mind that because these plans are run by private insurance companies, you will be required to follow their guidelines and you can incur high out-of-pocket costs if you do not.

As with any major healthcare decision, it is important to be informed before making any changes. Keep in mind that no matter what benefits you choose, you will likely be locked into your new plan until the fall of next year, so don't take any chances - educate yourself!

Before making any decisions, contact your medical professional or a trusted friend or family member to get more information about the benefits and disadvantages of each plan. And don't make any modifications to your benefits plan until you feel that you have all of the information you need to make the best decision for you.

Get Informed - Resources for Medicare Open Enrollment Information
In addition to talking with your medical professional, friends, and family members, free guidance is available from a number of sources to help you make the right choice during open enrollment.

- The federal government runs http://www.medicare.gov, the official site for Americans with Medicare.

- You can also call 1-800-Medicare, a toll-free hotline that addresses questions about benefits, prescription drug coverage, billing, and more.

- The Medicare Rights Center (MRC) offers free information and assistance about Medicare benefits at their web site: http://medicarerights.org.

- The Centers for Medicare & Medicaid Services' web site, http://www.cms.hhs.gov contains a wealth of benefit information, including a downloadable handbook.
About the Author
Mobility Guy writes articles about health, healthcare, wheelchairs, electric mobility scooters, power wheelchairs and more. Read more at the Mobility Scooter Blog .
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