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Helping a Loved One Navigate Medicare’s Open Enrollment Period

For the elderly and their families, fall means one thing—Medicare open enrollment. This can be a stressful time for both recipients of Medicare and their families, who often have to help navigate the enrollment process. If you’re helping a loved one handle open enrollment this year, here are a few things to know.

Know when to enroll

In previous years, the enrollment period ended on December 31 for the next year. This year, it starts on October 15 and ends on December 7—so if you haven’t thought about it yet, now is the time to get started.

Know what the possibilities are

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Medicare’s open enrollment can seem complicated and challenging. There is a lot to consider, and the stakes are high—both financially and in terms of health. But the process is easier if you can go in prepared.



This year, Medicare recipients can switch from regular Medicare to a Medicare Advantage Plan, which is usually a private HMO. They can also switch back to regular Medicare if they’re already in a Medicare Advantage Plan. Of course, if you or your family member is already receiving one of these plans and doesn’t want to switch, there is no need to.

Medicare only pays 20% of a doctor’s approved fee, so Medicare recipients will have to buy supplemental insurance to cover deductibles and co-insurance costs. They will also need to buy drug coverage under Part D. The actual advantage of Medicare Advantage Plans is that they often include all of this, so there is usually not a need to buy more insurance.

Know if your rates will change

If you or a loved one is enrolled in supplemental insurance or a Medicare Advantage Plan, chances are you’ve already received a notice of any rate changes that might be going into effect. If you haven’t gotten this in the mail, you may need to call the insurance company to find out.

Know what’s better—Medicare Advantage Plans or traditional Medicare.

Approximately one quarter of people who are eligible for Medicare enroll in the Medicare Advantage Plan. In general, Medicare Advantage Plans cost less than supplemental insurance and may cover many of the things Medicare does not—so there may not be a need for supplemental insurance. However, Medicare Advantage Plans also offer fewer options in terms of the hospitals you can use and the doctors you can see—so be sure your doctor and the hospital you prefer are both covered.

Know whether you need drug coverage

You might be tempted not to enroll in drug coverage now if you’re not taking a lot of prescription medication. But if you decide to join later, you could pay a late enrollment penalty—and that penalty will recur as long as you have the coverage.

It’s also important to make sure your pharmacy is included in the plan, whether you can use mail-order, co-payments for generic and brand-name drugs, deductibles, and so on. Check out the formulary offered by the plan to be sure the drugs you use are included.

Know where to go for more information

If you’re enrolled in regular Medicare and you want to change your supplemental insurance policy, you have some options. Your state’s department of insurance should be able to provide you with a list of providers that offer Medigap insurance—the supplemental insurance that covers what traditional Medicare doesn’t. You may also be able to get information on new Medicare Advantage Plan providers. Be sure to check out customer satisfaction information on these employers—the state department of insurance may be able to provide you with this as well. You can also use the federal government’s Medicare Plan Finder.

You may also see full-page ads from supplemental insurance providers; direct mail ads; local meetings run by insurance companies, and so on.

Medicare’s open enrollment can seem complicated and challenging. There is a lot to consider, and the stakes are high—both financially and in terms of health. But the process is easier if you can go in prepared. Do the math to figure out whether it would be best for you or your family member to get drug coverage, whether traditional Medicare or a Medicare Advantage Plan is right for you, and whether your current insurance company is raising its rates. With some careful planning and consideration, you should be able to find the best option for you or your loved one.