Medicare debuted in 1965 when President Lyndon B. Johnson signed a bill that created both Medicare and Medicaid. The programs’ purpose was to provide health care access for Americans who had difficulty getting it—namely older adults and those with limited incomes. Each part of Medicare covers a different range of health care services.
For an overview of what Medicare helps you pay for, read below.
Part A – Hospital insurance Part A helps pay for the costs of staying in the hospital plus more services. Here are common categories of Part A-covered services. Inpatient hospital stays and procedures Skilled nursing facilities Nursing homes Hospice care Home health care following an inpatient stay Blood you get in the hospital (after the first three pints each year) For more details, read our page about Medicare Part A.
Part B – Medical insurance Part B covers 100% of many preventive services, which includes services like these.
1. Counseling, therapy, and training: Alcohol dependency counseling Behavioral therapy to help lower your risk of heart disease Diabetes self-management training Medical nutrition therapy STI counseling Tobacco-cessation counseling
2. Doctor visits: Preventive visit, Annual wellness visit
3. Screenings and tests: Abdominal aortic aneurysm screenings Alcohol misuse screenings Bone mass measurements Breast cancer screenings (mammograms) Cardiovascular disease screenings Cervical and vaginal cancer screenings Colorectal cancer screenings Depression screenings Diabetes screenings Glaucoma tests Hepatitis C screenings HIV screenings Lung cancer screenings Obesity screenings and counseling Prostate cancer screenings Sexually transmitted infection (STI) screenings
4. Shots and vaccinations: Flu shots Pneumococcal vaccines Hepatitis B vaccines Another part of Part B is 80% coverage for the cost of most medically necessary services and items, including the following: Ambulance transportation services Blood and medical supplies Doctor visits Durable medical equipment (hospital beds, wheelchairs, walkers, etc.) Home health services Lab tests Outpatient care Surgeries X-rays Part B may also cover these services: Clinical research Mental health services Second opinions before surgery Limited outpatient prescription drugs Coverage for Part B services must be determined medically necessary or preventive. Visit our Part B resource page to learn more. Part C – Medicare Advantage plans Medicare Advantage, or Part C, plans are optional private plans that replace Part A and Part B but must have at least the same benefits. Sometimes, Advantage plans include more coverage than Original Medicare, such as these benefits: Dental services Vision services and eyewear (glasses, contacts) Hearing services and hearing aids Gym memberships Health and well-being programs
What is Open Enrollment?
Open Enrollment, also referred to as the Annual Election Period, is a period each year from October 15 through December 7, during which you can make changes to your coverage or enroll in a plan if you haven’t yet done so. Apart from special circumstances like moves or loss of employer coverage, this is the main time each year you can make changes to your coverage. As such, it’s important to take advantage of it.
What changes can I make during Open Enrollment?
During Open Enrollment you can do the following to change Medicare plans:
● Switch between Original Medicare and an MA plan ● Switch from one MA plan to another ● Drop or join a Part D Prescription Drug Plan (PDP) ● Switch from one PDP to another
How do I switch from Part A and Part B to an MA plan?
If you currently have Original Medicare--Part A and Part B—and you’d like to consolidate your coverage with an MA plan, you can do so during Open Enrollment. Before you enroll in a plan, you’ll want to compare the plans available in your area. Not all MA plans work the same or offer the same coverage. Once you’ve decided on a plan, all you need is your Medicare number and the date your coverage started, both of which can be found on your Medicare card. There are a few different ways to enroll:
● Use the Medicare Plan Finder and follow the subsequent instructions. ● Enroll on your plan’s website. ● Fill out a paper form (which you can get by contacting the plan you’re interested in). ● Call the plan and enroll over the phone. ● Contact Medicare at 1-800-433-4227. Once you enroll in a plan, your Part A and Part B coverage will automatically be rolled into the MA plan. You don’t have to worry about making any changes on that end.
How do I switch to a different MA plan?
If you’ve found an MA plan you like better than your current plan, switching is easy. Simply enroll in the new plan using one of the methods above during the Open Enrollment Period, and that’s it. You’ll be automatically removed from your old plan once the new coverage begins.
How do I switch back from MA back to Original Medicare?
If you decide you prefer the flexibility of Original Medicare, you can switch back during Open Enrollment. You’ll have to either contact your current MA plan or call Medicare at 1-800-433-4227 and let them know you want to switch back. They’ll take it from there. You can also switch from MA to Original Medicare during the Part C Disenrollment Period, which runs from January 1 to February 14 each year. If you make the switch during the Disenrollment Period, you also have until February 14 to enroll in a Part D plan. These are the only changes you can make during this annual Disenrollment Period.
How do I join a Part D plan?
If you need prescription drug coverage, you can sign up for a Part D plan during Open Enrollment. When signing up for a PDP, it’s important to remember that not all plans will cover all drugs. Each plan has its own list of covered drugs, called a formulary, so before signing up for any plan, you’ll want to review that plan’s formulary and make sure the prescriptions you take are covered. You can contact the plan you’re interested in to verify this. Once you’ve picked a plan, you can sign up using the following methods: ● Use the Medicare Plan Finder. ● Enroll on the plan’s website. ● Fill out a paper form. ● Call the plan. ● Call Medicare at 1-800-433-4227.
Can I drop my prescription drug coverage?
If you no longer want or need prescription drug coverage, you can drop your current plan without enrolling in a new one during Open Enrollment. There are several ways you can drop your plan: ● Call Medicare at 1-800-433-4227. ● Send a signed written notice to the plan that says you want to disenroll. ● Submit a request on the plan’s website. ● Call the plan and request a disenrollment notice that you then fill out, sign, and mail back.
How can I switch to a new Part D plan?
If you’re not satisfied with your current PDP, you can switch to a new one during the Open Enrollment Period. All you need to do is join a new plan using one of the methods above—the old plan will be canceled automatically when your new coverage starts.
Can I change Medigap plans during Open Enrollment?
Medicare Supplement (MS) insurance, also known as Medigap, helps pay some of the health care costs not covered by Part A or Part B. MS policies are offered by private insurers, and they do not follow the standard Open Enrollment rules. The MS enrollment begins when you first enroll in Part B after you’ve turned 65 (Part B is required to be eligible for Medigap). When you enroll in Part B, you have six months to enroll in an MS policy. After those six months, you can still consider changing Medicare Supplement plans, but you’ll be subject to the rules of the private insurer offering the policy. An insurer may, for example, deny you coverage based on pre-existing medical conditions.
Are there any other times I can change Medicare plans?
Following certain life circumstances, you may be allowed a Special Enrollment Period (SEP) that lets you make changes to your Medicare coverage. There are a variety of situations that can cause an SEP:
● You move to a new address that falls outside your current plan’s coverage area ● You move to a new address that adds additional plan options ● You move back to the US from another country ● You lose Medicaid eligibility ● You dis enroll from employer-provided health coverage ● You become eligible for insurance offered by your employer ● Medicare terminates your plan’s contract The time frame for Special Enrollment Periods varies for each situation that arises, so if you become eligible for an SEP, make sure you act quickly. You can also consult the full list of circumstances and the duration of each enrollment period at Medicare.gov.
