Understanding Medicare and Open Enrollment Periods

Medicare is a useful service …

and a lifeline for those who cannot afford more expensive policies, but it is a confusing thing to navigate and understand.

Yes, you’ll get sent a handbook with some information about Medicare policies in the mail, but let’s face it, that handbook is tricky to understand. You’ll be bombarded with ads from insurance companies that want to sell you services, and you’ll be sent loads of information about Medicare that, well, you can’t quite figure out.


That’s perfectly normal. The Medicare system is intended to support a huge population of people with different financial and health circumstances at different stages of their lives. If you haven’t spent time sitting down and reading about it, then understanding the different plans and the open enrollment periods and options can be pretty tricky. It doesn’t have to be that way. Advice is out there – and whether you’re someone who is taking advantage of open enrollment just in case, or you’re new to Medicare and planning on making it your primary insurance, you have options open to you.

Who Can Get Medicare?

If you’re over 65 and have been a permanent resident of America for at least 5 years, then you can sign up for Medicare. If you’ve been on Social Security Disability for 24 months, then you can get Medicare too. Those who are aging into the Medicare system at 65 don’t have to be taking Social Security to qualify for Medicare coverage.

Start with the basic Medicare coverage before you start looking at other bits of the system. The Medigap plans can be confusing, but they’re really just added extras. Original Medicare includes Part A and Part B, which are federal systems that you enroll into through your Social Security office. You might find that you get a lot of spam about additional Medicare cover, and you can safely ignore that stuff. The parts of Medicare that you really need to pay attention to are Part A – Hospital Cover, and Part B – Outpatient cover.

What You Get With Medicare Coverage

Medicare Part A covers room and board in hospitals and nursing facilities. Part B covers lab tests, surgery, diagnostics, trips to the doctor, etc. There’s another important piece of cover, Part D, which covers prescriptions. If you don’t want to pay for medication out of pocket, then you’ll want to have Part D cover. Considering how expensive some brand name drugs can be, it’s really important to have Part D, and it is worth the extra expense. Once you’ve sorted that you can start thinking about the other bits of coverage available.


Joining Medicare

There is a window of time during which people can re-evaluate their coverage or enroll into different parts of Medicare. This period is called open enrollment. You have a window where you can switch to or from Medicare Advantage, join Part D if you aren’t already on it, or switch to a different provider. This year, open enrollment begins on October 15 and ends on December 7th. There’s another window for people aging into Medicare, which is focused around their birthday. Changes made during the Medicare Open Enrollment period are effective from January 1st.

Medicare doesn’t cover Medigap. These plans are only guaranteed-issue in the vast majority of states, during the beneficiary’s initial enrollment period.

There are some other limited, special enrollment periods for Medigap as well. If you miss the window then you will have to wait for the next opportunity to choose your plan. For this reason, it’s a good idea to start planning ahead. If you’re happy with your plan then you don’t need to do anything, but if you’re not then you can move over during the enrollment window and get a better deal.

Make sure you read your Evidence of Coverage or Annual Notice of Change to ensure that you’re on the right plan. You should be sent information by your provider before any moving deadlines, and you can use that info to make decisions about the coverage that you need. Be sure that you are opted into the required coverage if you are over 65, so that you have your basic medical needs covered.

Why Go It Alone

You can always call us at 1 800 717 2183 if you have any questions whatsoever. We’re always happy to hear from new and existing clients. Visit our contact page and send us a message. We’d love to hear from you.