Medicare Open Enrollment

Medicare open enrollment is from October 15 through December 7, 2015.  This gives seniors an opportunity to switch their Medicare Plan if they are on an Advantage Plan or switch back to Original Medicare (Part A and B).  They can also switch their prescription drug coverage.  Medicare Open Enrollment occurs at the same time every year and the new coverage selected begins January 1st the following year.

Many people confuse Medicare Part A and B with Part C plans (or they simply do not realize what type of plan they have).  Medicare open enrollment gives you the opportunity to educate yourself about the types of plans that are available to you.   Some people have Original Medicare and a Medigap supplemental plan, and if they are happy with that, may decide not to keep that coverage.  However, some people have Medicare Advantage Plans (Part C plans) and/or a Prescription Drug Plan (Part D) and may not be happy with the plan they have.  Medicare open enrollment gives them the chance to change the plan they are with.

What are the advantages of being on an “Advantage” plan (also known as a Part C plan)?  These plans allow seniors to receive Part A and B benefits through a private health insurance company that contracts with Medicare.  While these plans cover hospitalization and outpatient care and they might also provide extra services that Original Medicare does not cover, such as dental, vision and hearing, as well as some may include prescription drug coverage.

What are reasons to go with a Part C plan over Original Medicare?   First of all, Medicare does not cover prescriptions unless you have a Part D drug coverage.  However, many Part C plans include drug coverage.  Second, if you are concerned about your out-of-pocket health spending, then a Part C plan may be for you.  Original Medicare does not have a cap on out-of-pocket expenses – you pay a portion of the cost of services as you use them.  However, Part C plans do have a maximum limit so that, if someone reaches their limit, the plan will cover 100% of the remaining Original Medicare-covered costs for the rest of the year.  The mandatory maximum out-of-pocket limit for 2015 is $6,700.  Some of the costs that are included towards this limit include primary care or specialist co-pays, ER visit co-pays, hospital stay deductibles and co-pays, coinsurance for radiology services, co-pays for outpatient rehab services, co-pays for outpatient hospital visit or ambulatory surgical center visits.

Why would you want to stay with Original Medicare?  If you are interested in choosing your doctors and want a wide variety to choose from, more doctors accept Original Medicare than private Part C plans.  If you travel a lot, you may want to keep Original Medicare.  Additionally, if you are concerned about having to receive prior authorization from a primary care doctor before seeing a specialist, Part C plans are usually HMO’s which would require prior authorization, or PPO plans which would limit you going out-of-network.  Other reasons to stay with Original Medicare include if you have an employer-sponsored retiree health benefit that supplements your Medicare, then an advantage plan would not be necessary or if you are a low income beneficiary, you may qualify for Medicaid or a Medicare Savings Program that will help pay for co-pays, deductibles and out-of-pocket expenses.

If you have questions about Medicare Open Enrollment, you can go on the Medicare. Gov website to shop for plans at or, in Florida, you can contact your local SHINE office where you can speak to a counselor is trained in helping you understand your Medicare benefits, select prescription drug plans and advise you on programs that can lower healthcare costs.  You can find out more information about the SHINE program by going to or calling 1-800-96-ELDER.  Additionally, the Justice In Aging law center has a fact sheet about Medicare that you can Download here.

If you have questions about Medicare or Medicaid, please contact the Law Offices of Laurie E. Ohall, P.A.

By |2015-12-04T11:10:26+00:00December 4th, 2015|Categories: Elder Law, Medicare|Tags: , |0 Comments