Medicare open enrollment options
If you are already enrolled in Medicare — health insurance for the disabled and over 65 — you likely know the basics and more about the program. Now is your time to consider “open enrollment” to make changes to your coverage.
Each year, you can make changes to your Medicare coverage for the following year.
Medicare basics
Medicare is health insurance for people 65 or older or those who are/become disabled. You’re first eligible to sign up for Medicare three months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). Generally, a Medicare health plan:
Is offered by a private company Contracts with Medicare to provide Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) benefits to people with Medicare who enroll in the plan
Additional Medicare health plans include Part C coverage, which includes Medicare Advantage — which in most cases limits you to doctors who are in the plan’s network and can include extra coverage like vision, hearing, dental and prescription drugs — and Medicare supplemental medigap plans, which are standardized and in most states are named by letters, such as Plan G or Plan K. There is also Part D coverage (prescription drug coverage). These help cover out-of-pocket costs not covered by Parts A and B.
Initial enrollment
Most people sign up for both Part A (hospital insurance) and Part B (medical insurance) when they’re first eligible, usually when they turn 65. Generally, there are risks to signing up later, like a gap in your coverage or having to pay a penalty. However, in some cases, it might make sense to sign up later. The initial enrollment period lasts for seven months, starting three months before you turn 65, and ending three months after the month you turn 65.
When you apply for retirement or disability benefits from Social Security or the Railroad Retirement Board, it also serves as your application for Medicare. Once you get approved for Social Security or Railroad Retirement Board benefits, you’ll automatically get Part A coverage without having to pay a premium for it once you’re eligible for Medicare.
If you’re getting benefits from Social Security or the Railroad Retirement Board at least four months before you turn 65, you’ll automatically get Part A coverage. You’ll also be signed up for Part B unless you live in Puerto Rico or outside the U.S. Because you pay a monthly premium for Part B coverage, you can choose whether to keep it or not. See the Medicare website, medicare.gov, for information on when coverage starts.
Coverage options
Once you’ve signed up for Part A (hospital insurance) and Part B (medical insurance), you can choose which way you get your health coverage. The Medicare website, medicare.gov, has a section on comparing original Medicare, supplemental Medicare medigap plans, Medicare Advantage plans and prescription drug plans so you can see what’s best for you and your budget. There are many plans available in New Mexico, so plan on spending time reviewing your options.
Open enrollment
■ Oct. 15 through Dec. 7 It’s now open enrollment for Part C supplemental Medicare medigap plans and Medicare Advantage plans, and Part D Medicare prescription drug coverage plans. At this time you can switch plans, mix and match plans, and decide if you want a plan that includes medical and drug coverage, separate plans for medical and drug coverage, or no drug coverage at all. Coverage starts Jan. 1 of the new year. Information on what is available in New Mexico is at medicare.gov. Medicare plan providers in New Mexico may be holding enrollment events. Watch for announcements.
Want help with Open Enrollment or Initial Enrollment? Contact New Mexico ADRC-State Health Insurance Assistance Program (SHIP) to get free personalized health insurance counseling. 1-800-432-2080, nmaging.state.nm.us/
■ Jan. 1 through March 31
This is the open enrollment period for those already enrolled in Medicare Advantage plans. If you’re in a Medicare Advantage plan, with or without drug coverage, you can switch to another Advantage, back to original Medicare with or without a supplemental medigap plan and/or to a separate prescription drug plan.