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Medicare Insurance Comparison

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What does open enrollment for Medicare mean?

Just the essentials...

  • Medicare is the national health care system for older Americans

  • Medicare plans meet the coverage requirement of the Affordable Care Act

  • Medicare plans meet the coverage requirement of the Affordable Care Act

  • Medicare open enrollment runs from October 15 through December 7 every year

  • Medicare open enrollment runs from October 15 through December 7 every year

What does open enrollment for Medicare mean?

Medicare is a comprehensive system of health insurance and medical care for older Americans. It has an annual open enrollment period in October of each year that is the ideal time to get coverage, change coverage, and compare plans.

Comparison shopping is the ideal method for finding the best health plans in Medicare Advantage, Medicare Supplement, and Part D: Prescription Drugs. Using comparison shopping, consumers can rate plans by the features most important to them.

Explore all your options before you enroll in Medicare. Enter your zip code above for a free, customized quotes comparison!

Open Season and the Individual Mandate

What does open enrollment for Medicare mean?

The Affordable Care Act requires that every eligible person get and keep qualified health insurance. Qualified insurance has prevention and wellness, the essential health benefits, costs controls on deductibles, and limits on out-of-pocket expenses. It must also meet the minimum value of sixty-percent insurance-paid benefits. The below-listed parts of Medicare meet the individual mandate.

  • Medicare Part A
  • Medicare Advantage Plans
  • Original Medicare

Open Season for Good Reasons

Each year Original Medicare and the Medicare Advantage plans change. They can add features, change prices, and make additions and subtractions to the network of medical care providers. The open season is a great time to review plan details, assess changes in current insurance arrangements, and make improvements.

The Medicare Open Season comes at a time when CMS releases new plan information for the upcoming calendar year. Medicare Advantage plans must compete for the consumer’s interest, and their changes can be in low-cost services, additional services, or lower out-of-pocket expenses.

Comparison shopping is an effective tool for finding the effects of changes in plans.

Medicare is Made of Parts

Open season is the time for consumers to consider the changes in the major Parts of Medicare. The Congress enacted Medicare in Parts. Original Medicare came first. It was followed by Medicare Part C that introduced private insurance plans to Medicare. The latest was the Affordable Care Act which made some important changes and added financial security.

  • Part A: Hospital Insurance focuses on in-patient treatment and hospitalization. It includes the services and equipment deemed medically necessary to treat the disease, illness, or condition.
  • Part B: Medical Insurance has coverage for medical care providers and outpatient services. This includes durable medical equipment for home usage.
  • Medicare Advantage plans are private insurance plans that equal or exceed Original Medicare coverage.
  • Part D: Prescription Drugs is the insurance protection that covers the costs of medication. Medicare reviews the drugs formularies and costs in these private insurance plans; Medicare requires up-to-date lists of covered drugs.
  • Medicare Supplement is gap insurance that can pay part of the consumer’s coinsurance from Medicare Part A and Part B.

Original Medicare or Medicare Advantage?

What does open enrollment for Medicare mean?

A big choice facing every Medicare enrolled person is whether to use Original Medicare or try an all-in-one Medicare Advantage plan. The difference can be great as Original Medicare requires a few additional choices about prescription drug coverage and help with out-of-pocket costs.

Medicare Advantage plans can combine all of the features of Medicare into one package for the consumer. These plans can include prescription drug insurance, medical insurance and hospitalization, and some reduction in costs such as fewer copays and lower coinsurance than Original Medicare.

Original Medicare is Government-Run Insurance and Care

Open season calls for choices and Original Medicare differs from Medicare Advantage in an important way; Original Medicare is a government-run program. The Centers for Medicare and Medicaid manage the system. They use thousands of private contractors to support the system that involves more than $300 billion in annual payments.

Open season is an opportunity to review Original Medicare programs for extra help for low-income subscribers.

Understanding the Types of Managed Care

What does open enrollment for Medicare mean?

Health insurance providers use their networks to provide services and control costs.

The below-listed items highlight the benefits and restrictions of Medicare Advantage plans.

  • HMO is the health maintenance organization. It emphasizes prevention and wellness as well as regular medical care. The HMO uses a primary care physician to provide care and refer patients to other network resources.
  • PPO is the preferred provider organization. This type of care does not need referrals, and members can use any network resource. Some plans charge the rates of Original Medicare when using doctors outside the network.
  • HMOPOS is the health maintenance organization model with the primary care physician. The Point of Sale option gives the primary care doctor the power to refer to outside specialists at a lower cost-sharing rate than when using network resources.
  • EPO is the exclusive provider network. It permits subscribers to use any resource without referrals or primary care physician approval. It does not cost share with outside resources.
  • FFFS is the fixed-fee-for-services type of managed care. Original Medicare uses a fixed-fee-for-services style to manage care among a national network of thousands of doctors and medical services providers.

Review Reports of Plans and Changes

Consumers must take the time to notice the changes in the current plans so that they can continue to get the benefits they wish to have. Medicare requires that providers send annual reports of coverage and reports of changes to each subscriber.

The Advantage of Medicare Advantage

What does open enrollment for Medicare mean?

Medicare Advantage plans must do the work of Original Medicare, but the law encourages the private sector to come up with better ways to do it. The Congress intended that Part C bring innovation and wider ranges of choices for the Medicare consumers.

The law also brought a familiar style; many consumers had seen similar health care plans from private insurance companies. The familiar structures of managed care included HMO, PPO, and EPO arrangements that featured network restrictions and cost sharing.

Prescription Drug Benefits

The open enrollment is a great time to get or change prescription drug insurance. Prescription drugs are an important part of medical treatment in the US. Doctors treat many conditions and illnesses with powerful medications that allow the patient to function without hospitalization.

Many Medicare users find that the costs of medications can be a financial burden. Some find that due to large annual spending for drugs that they get to the unprotected part of the market with little price protection. Called the ”donut hole,” consumers pay far more than they wish in this spending zone.

Open Enrollment is Time for Changes

What does open enrollment for Medicare mean?

Open Enrollment is the best time to review and change Medicare coverage. The annual open enrollment runs from October 15 through December 7, each year. During Open enrollment, consumers can switch from Original Medicare, add Prescription Drug benefits, and Medicare Supplement. The CMS exercises oversight over the entire system keyed to the annual cycle.

Medicare Advantages policyholders can change plans or switch to Original Medicare. Comparison shopping is the powerful tool that makes the best of the Medicare open enrollment period.

Enter your zip code below to get free private Medicare insurance quotes today!


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