When you first became eligible for Medicare, it is likely that you were automatically enrolled in Part A and signed up for Part B so that you could receive the medical insurance you need. You pay a monthly premium for Part B.  If you get your Part A and Part B benefits from Original Medicare, you may have purchased a Medigap policy to help supplement your health care coverage. You may also have added a Part D, or Prescription Drug Plan (PDP), which helps cover the costs of your prescription drugs.

Instead, you may have chosen to receive your Part A and Part B benefits through a Part C plan, otherwise known as a Medicare Advantage Plan. Medicare Advantage plans are offered by a private insurance company contracting with Medicare, and must offer at least what Original Medicare does. Many offer additional benefits. These benefits can vary greatly from plan to plan, and could include vision, dental, and hearing care, or even fitness club memberships. You may have decided that an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) fits your lifestyle, and you might have chosen an MA-PD plan (Medicare Advantage with prescription drug coverage).

Regardless of how you have been receiving your Medicare benefits, you have the annual opportunity to make changes to your health care coverage during the Annual Election Period, often referred to as Open Enrollment, from October 15 through December 7.  This period of time allows you to compare other plans available in your area. You can compare the costs (including premiums, deductibles, copayments, coinsurance, and other out of pocket costs) of individual plans and the benefits they offer so that you can ultimately choose the one that best meets your individual needs.

Because of the late enrollment penalty that most beneficiaries can incur if they do not sign up for Part B or Part D when they are first eligible, many beneficiaries choose to add Part B and Part D as soon as they reach eligibility. If you have Part B, you pay a Part B premium each month. If you have Part D, you pay a Part D premium each month. Most people will pay the standard premium amount for Part B and Part D, but Social Security will contact some people who have to pay more depending on their income. For Part D premium, you may qualify for extra help in paying for your Part D premium if you have limited income and resources. Contact Social Security to apply for extra help.

If you join a Medicare Advantage (MA) Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer additional benefits, such as vision, hearing, dental, and/or health and wellness programs, and many include Medicare prescription drug coverage (Part D). You will pay one monthly premium for the MA plan, in addition to your Part B and Part D premium.

Medicare Part B coverage is important to many beneficiaries, and the possibility of an increase in the Part B premium can cause them a great deal of anxiety. Thankfully, there is only a minor increase in the Medicare Part B premium for 2012.  According to Kathleen Sebelius, Secretary of Health and Human Services, the Part B premium is

“…rising by only $3.50 despite earlier projections of a much bigger jump…In addition, Medicare’s Part B deductible will actually fall by over $20, from $161 to $140.”[1]

More than making up for the increase in the Part B premium is a rise in Social Security benefits for 2012. According to the Centers for Medicare & Medicaid Services,

“Social Security benefits are rising 3.6 percent to cover inflation – the same percent increase as Medicare’s premium.”[2]  This is good news for the many beneficiaries on a tight budget.

Use the opportunity of the Annual Election Period to review your budget and health care coverage needs in order to choose the Medicare health care coverage that meets all of your needs.

As you look at your Medicare Advantage choices, you will want to keep your own preferences in mind as you explore your options. You may want to review the differences between the provider networks, costs, and benefits of HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) plans. You should evaluate your lifestyle and needs in relation to those plans available in your area, and be honest with yourself. If you prefer to visit specific doctors, specialists, or hospitals, you may want to check the network of any plan you are considering.

Benefits and costs will differ within any given area, but the best way to narrow your choices is to focus on your individual, personal priorities. Medicare Advantage plans will offer at least the same level of coverage that Original Medicare does, but many MA plans offer a variety of additional benefits. For instance, you can choose an MA plan with or without prescription drug coverage. This is an essential difference between plans – if prescription drug coverage is important to you, you will want to make certain that any plan you consider includes this benefit.  Some plans will provide vision, dental, or hearing services, while others may include wellness and fitness programs.

Health care coverage costs can change in a variety of ways. Many beneficiaries are naturally concerned about increases in premiums or deductibles, but costs can rise in other ways as well. For instance, if you have an MA-PD (or Medicare Advantage plan with prescription drug coverage), prescription drugs may be moved to a different tier within a plan’s formulary, which could cost you more. Take the time to research the details of any plan you are considering.

Any changes you make to your health care coverage during the AEP will be effective January 1.

There are a variety of factors involved when you explore Medicare health care coverage options, and many include very personal needs or preferences. Your lifestyle, budget, health, and long-term goals are all important elements to consider as you compare Medicare coverage choices.  You may have found that Original Medicare suits your needs, possibly with the addition of a Medigap (Medicare Supplement) policy and/or a Prescription Drug Plan. If you have discovered that additional benefits would add value to your health care coverage, you may find a Medicare Advantage (MA) plan or a Medicare Advantage with Prescription Drug (MA-PD) plan that will accommodate your lifestyle.  You should not have to compromise who you are in order to receive the health care coverage you deserve.

Even though Medicare is an individual coverage plan, your family certainly factors into any important decisions you make, and there is no decision as important as your health care coverage.  You and your spouse may travel a great deal, or perhaps volunteer abroad.  You may have adult children with families who you like to stay with on extended visits. In these cases, you may want a flexible health care plan that will follow you as you move around.

Other factors can affect your personal choices, as well. You might have a specific physician or specialist you want included in your medical care, or you may have certain durable medical equipment (DME) needs that have to be met.  Every beneficiary will bring individual requests, preferences, and needs to their Medicare decision-making process and should help guide you to the plan that is right for you.

The good news is that there could be many options available to you in your area.  Medicare Part C options include a variety of offerings, including Medicare Advantage HMO (Health Maintenance Organization) Plans, PPO (Preferred Provider Organization) Plans, and Private Fee-for-Service (PFFS) Plans. You may be eligible for a Special Needs Plan (SNP) or you might consider less common Medicare Advantage plans, such as an HMO Point of Service or Medical Savings Account (MSA).  Take the time you need during the Annual Election Period (AEP) to evaluate your choices. Comparing the plans available to you can help lead you to the plan that fits your individual needs.

Some beneficiaries have chosen to add a stand-alone Prescription Drug Plan (PDP) to their Original Medicare coverage, while others have chosen to receive their Medicare coverage through a Medicare Advantage plan that includes prescription drug coverage.  Regardless of which type of plan you currently have, you should have already received your updated 2012 benefit information. Taking the time to review these documents may make a big difference in your prescription drug costs next year.

If your current plan continues to offer the prescription medications you need at the costs that fit your budget, you may decide that your current coverage will continue to serve your needs. Unfortunately, you may find that your prescription medications have increased in cost. For instance, a medication that was previously designated as a Tier 1 drug on your plan’s formulary might have moved to Tier 2, costing you more throughout the next year. If this is the case, it might be time to take advantage of Medicare’s Annual Election Period to compare plans.

Medicare’s Annual Election Period, from October 15 through December 7, is the time of the year during which you can make changes to your current health care coverage, including any changes to your prescription drug coverage.  You can compare Medicare Advantage Plans that include prescription drug coverage, (MA-PDs), and you can compare stand-alone Prescription Drug Plans (PDPs).

As you compare these plans, make sure you check each plan’s specific formulary if there are specific medications you require. Some formularies may vary in the medications they cover or the cost for those drugs. Even though Medicare requires that all plans cover certain prescription drugs, plans may offer them for a variety of costs. It is in your best interest to be as specific as possible when you compare plans. Have the names and dosages of the prescriptions drugs you currently depend on handy when you compare plans. This will help you find the best plan for your individual needs. It also helps to know what you have paid for these drugs in this past year, so you will be able to identify a better option, if one exists. You may find that your current plan is the best one for your needs, and in that case, your coverage can continue. Comparing plans and choices will provide you with the assurance that you are receiving the health care coverage that best fits your needs.

After October 1, you will have access to updated plan information from Medicare Advantage plans, and you can review the 2012 Medicare & You Handbook updated and released by the federal government.  This information will prepare you for any decisions you make during the Medicare Annual Election Period (AEP) from October 15 through December 7.

If you have Original Medicare, or would like to revert back to Original Medicare after having Medicare Advantage plan coverage, you can do so during the AEP. You can also choose to add a Prescription Drug Plan (PDP) to your Original Medicare coverage during this time. After the Annual Election Period, you have another opportunity to return to Original Medicare. The Medicare Advantage Disenrollment Period from January 1 through February 14 allows you to drop your MA plan and return to Original Medicare. If you return to Original Medicare during this time, you may also add a stand-alone Prescription Drug Plan (PDP).

If you currently receive your Medicare coverage through a Medicare Advantage plan, but would like to switch to a different plan for lower costs or the additional benefits offered, the Annual Election Period is your time to do this.

If your Medicare Advantage plan is discontinuing its participation is the Medicare program for 2012, you will automatically be enrolled in Original Medicare, unless you join another Medicare Advantage Plan. If you choose to stay in Original Medicare, you will have the right to purchase certain Medicare Supplement (Medigap) policies. If you need prescription drug coverage, you can also join a stand-alone Prescription Drug Plan.

If you want to continue to receive your Medicare coverage through a Medicare Advantage Plan, you need to join a new plan for the coming year. You will have a special election period from October 1 until January 31 to enroll in a new plan. You should join a new Medicare Advantage Plan by December 31 in order to make sure you have coverage as of January 1. If you do not join a Medicare Advantage Plan by December 31, you will continue to have Medicare coverage through Original Medicare only, as of January 1. You may still enroll in a Medicare Advantage Plan between January 1 and January 31 however your effective date with the new plan will be February 1.

If you are in a Medicare Prescription Drug Plan that is no longer participating in Medicare in 2012, you have the right to join another Medicare Prescription Drug Plan or a Medicare Advantage Plan with drug coverage. If you do not join a new plan, you will not have Medicare prescription drug coverage (Part D).

With Medicare’s Annual Election Period (AEP) coming soon, from October 15 through December 7, this is an important month for you to receive important health care related documents. This crucial reading material will help you make important decisions during the AEP, and will guide you in your health care coverage throughout the coming year.  Your Medicare Advantage plan’s Annual Notice of Change will be arriving soon, as well as your Summary of Benefits. These papers should be reviewed when they arrive. There may be changes to your benefits, lower or higher costs, or even additional benefits being offered. Keep these papers in a safe, easy-to-access area so that you can review your benefit, cost, and coverage changes for 2012.  You should be receiving this information by October 1, so you will have time to read the documents, consult with trusted advisors or loved ones, and even compare your current needs to your updated Medicare coverage information.

All Medicare beneficiaries will also be receiving the 2012 Medicare & You Handbook, an indispensable resource that can be referred to throughout the year for invaluable information. Any changes made to Original Medicare for the 2012 coverage period will be noted in this Medicare & You Handbook, along with answers to many of your Medicare health coverage questions.

After October 1, you may also find marketing materials from various Medicare health plans arriving, as they want to introduce you to their coverage options. The Annual Election Period is the opportunity for Medicare beneficiaries to make any changes they need to their health care coverage, and the more information you have at your fingertips, the better prepared you will be to evaluate your current coverage and make changes if you need to.  If you review your coverage, compare your needs with your current plan as well as other plans available in your area, and find you do not need to make any changes, you do not have to do anything except file your coverage documents in a safe place.

You are ready to map out your adventure, and may have a starting point by now.  You may have already made a list of what needs and preferences you have that changed over the past year due to illness, injury, relocation, or a change in your lifestyle. You are ready to take what you know from personal experience and apply it to your annual review of this important aspect of your life.

Before you embark on the Road to Medicare’s Annual Election Period, October 15 through December 7, there are still a few things you will need to do before making a final decision about your destination. You have time now, prior to the AEP, to review your current health care coverage.

The 2012 Medicare benefits will be announced within the next month, and you will want to be prepared to reflect on what aspects of your health care coverage met your needs, and what, if any, additional preferences you have now.

If you already belong to a Medicare Advantage plan, you may want to review your current coverage and review the new 2012 benefits from that plan when your updated benefit information arrives within the next month. When you receive updated benefit information from your current plan, you should read it carefully to determine what changes might affect your individual circumstances.  There may be minimal change to the plan’s offerings, and you may choose to continue to receive your coverage through that plan if it still meets all of your needs.

As you would with any trip, you will probably review other options as well. It is always better to have knowledge of available plans in your area so you can make an educated decision. Just as you would explore brochures from different hotels or vacation packages, you will peruse the materials available from other plans available to you. Once the 2012 benefits are announced, you can also use free, easy to use on-line comparison tools like Joppel.com to make sure you find the health care coverage that is right for you.

Before you start packing boxes, make sure that your medical records and health care information is filed in a safe place where you can access it at any time. Make sure that any necessary documentation, such as your Medicare identification card, does not get lost in the shuffle of boxes and packing tape. Take the time to consider your Medicare options before you move, as different plans are available in different regions.

If you are moving to a new address that is not included in your current plan’s service area, or you are moving to a new address that offers you new plan options, you can switch to a new Medicare Advantage or Medicare Prescription Drug Plan.  If you inform your plan before you move, you will have a period of time to switch plans. This period of time includes the month before the month you move and continues for 2 full months after you move.  If you wait to tell your plan until after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months.

If you have been living outside the country, and you move back to the United States, you can join a Medicare Advantage or Medicare Prescription Drug Plan during the enrollment period that lasts for 2 full months after the month you move back to the United States.

If you just moved into, currently live in, or just moved out of an institution (such as a skilled nursing facility or long-term care hospital), you can join a Medicare Advantage or Medicare Prescription Drug Plan, or you can switch from your current plan to another Medicare Advantage or Medicare Prescription Drug Plan. You also have the option to drop your Medicare Advantage Plan and return to Original Medicare, or drop your Medicare prescription drug coverage. Your chance to join, switch, or drop coverage lasts as long as you live in the institution and for 2 full months after the month you move out of the institution.

You also have a special enrollment period if you have been released from jail. You can join a Medicare Advantage or Medicare Prescription Drug Plan for the 2 full months after the month you’re released from jail.

If you already have Medicare and are wondering if you have Part B, you can check your Medicare card to find out. If you are not eligible for Medicare yet, when can you get Part B? In most cases, if you are already getting benefits from Social Security or the Railroad Retirement Board (RRB), you will automatically get Part A and Part B starting the first day of the month you turn 65. If your birthday is on the first day of the month, Part A and Part B will start the first day of the prior month. If you are under 65 and disabled, you automatically get Part A and Part B after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months. You will get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability.

It is important to note that if you do not want Part B, you should follow the instructions that come with the card, and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.

If you are not getting Social Security or RRB benefits (for instance, because you are still working) and you want Part A or Part B, you will need to sign up (even if you’re eligible to get Part A premium-free). You can sign up for Part B when you are first eligible for Medicare during your 7-month Initial Enrollment Period. For example, if you are eligible for Part B when you turn 65, your initial eligibility period spans a 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

If you do not sign up for Part B when you are first eligible, you can sign up between January 1 – March 31 each year, and your coverage will begin July 1. You may have to pay a higher premium for late enrollment. If you do not sign up for Part B when you are first eligible, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it. Usually, you don’t pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a special enrollment period.

How much will Part B cost? If you choose to sign up for Part B, most people will pay a standard monthly premium. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you may pay more.

Why wait to enroll in Part B? There are situations in which you might choose to delay signing up for Part B. For example, if you or your spouse (or family member if you are disabled) is still working and you have coverage through an employer (including the Federal Employee Health Benefits Program) or union, contact your employer or union benefits administrator to find out how your insurance works with Medicare. It may be to your advantage to delay Part B enrollment.

You may need to enroll in Part B in certain circumstances. If you enroll in a Medicare Advantage Plan, you will need to have Part and Part B.  If you have Part A and TRICARE (coverage for active-duty military or retirees and their families), you must have Part B to keep your TRICARE coverage. However, if you are an active-duty service member, or the spouse or dependent child of an active-duty service member, you do not have to enroll in Part B to keep your TRICARE coverage while the service member is on active duty. Before the active-duty service member retires, you must enroll in Part B to keep TRICARE without a break in coverage. You can get Part B during a special enrollment period if you have Medicare because you’re 65 or older, or you’re disabled.