Clearing up confusion about Medicare’s open enrollment period

Dear Toni: This is my first Medicare open enrollment period. I’m still confused about what I need to do.

I don’t know anything about the open enrollment process or how I can make a change. How do I find out which options are right for me? I have health problems, and I’m concerned — which Medicare health plan and prescription drug plan do I choose? — Phyllis, Denver

Dear Phyllis: It’s important to take your time and research your options. Here are three steps the Toni Says team uses when helping clients during Medicare’s open enrollment period (Oct. 15-Dec. 7).

Step 1: Decide whether you want original Medicare (Parts A and B) or a Medicare Advantage with a prescription drug plan (Part C).

Ask your doctor’s office which plan it recommends. Most doctors accept original Medicare, but not all accept Medicare Advantage plans. If your provider is in a Medicare Advantage plan’s directory, you’ll want to call that specific doctor’s office to ensure they will accept that plan for the upcoming year.

Medicare Advantage plans differ from original Medicare in that they are administered by private insurance companies that are approved by Medicare and are primarily HMO and PPO plans.

If you choose a Medicare Advantage plan, you must use that specific insurance company’s card, not your Medicare card, to pay claims. With original Medicare and a supplemental or Medigap policy, you will use your Medicare (red, white and blue) card to pay claims with the Medicare Supplement paying the Medicare out-of-pocket.

Step 2: Decide if you need to enroll in or change your Medicare Part D prescription drug plan.

If you want prescription drug coverage to go with original Medicare, you must enroll in a stand-alone Medicare Part D plan, and there might be a monthly premium.

If you choose a Medicare Advantage plan, make sure that the plan has Part D drug coverage included to keep you from receiving a penalty for not enrolling in a Medicare drug plan.

Verify that your medications are in the Medicare Advantage or stand-alone Part D plan’s formulary.

Step 3: Don’t miss the deadline. Remember, you have from Oct. 15 to Dec. 7 to change your Medicare Advantage plan or stand-alone Medicare Part D coverage, and the change will begin Jan. 1.

If you miss the deadline, you will have to wait until the next year’s open enrollment period.

This window is only for enrolling in or changing Medicare Advantage or Part D plans. Changes to your Medicare supplement, long-term care or dental plans can be made at any time.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.