Medicare is an important, but often confusing, benefit for Older Adults. Unlike many of the benefits we highlight in this blog, Medicare is a benefit that is not restricted by income or assets. Anyone over age 65 or with a disability is eligible for Medicare. Medicare is broken down into parts and the different parts of Medicare cover different services. Part A typically covers only In-patient services, Part B covers things like doctors’ visits, medical equipment, outpatient procedures and other services. Once you are eligible for Parts A and B, you enroll through Social Security. For more information about Medicare Enrollment, you can read our Ask An Aging Expert blog on Medicare Enrollment Periods.
Where Medicare starts to get a little more complicated is in Parts C and D. Medicare Part C, or Medicare Advantage Plans, aren’t truly a “Part” of Medicare. A Part C plan is really more of a re-packaging of Part A and B benefits. Part C plans are offered through private insurance companies and often include other benefits not covered under Parts A and B. Most Part C plans also include prescription drug coverage, or Part D coverage. Like Medicare Advantage Plans, Part D plans are offered through private insurance companies and offer coverage for prescription drugs.
While Part C and D plans are optional additions to Medicare, the vast majority of people with Medicare are enrolled in either a Part C or Part D plan. Special plans are also available for people who have both Medicare and Medicaid. Since needs change over time, Part C and D plans have an Annual Open Enrollment Period so people can make changes to their coverage. Each year in September, plans send an Annual Notice of Change to enrollees. When you receive this notice, it is time to start considering new coverage. If your plan is changing its monthly premium, deductible, network of pharmacies or copay amounts, those changes will be in the Annual Notice of Change. The Annual Notice of Change will also inform beneficiaries that they can change their plan during the Annual Open Enrollment Period.
Beginning on October 15th of each year, the Annual Open Enrollment Period is a time for people with a Medicare Advantage Plan or Part D plan to change their coverage for the upcoming year. During this time, you can make certain changes to your health insurance coverage, including adding, dropping, or changing your Medicare Advantage and Part D coverage. Even if you are happy with your current health and drug coverage, The Medicare Annual Open Enrollment Period is a good time to review what you have, compare it with other options, and make sure that your current coverage still meets your needs for the coming year.
If you feel you would benefit from a plan review, the Area Agency on Aging – Five County is here to help. Staff and volunteers with the State Health Insurance Assistance Program (SHIP) can help local Medicare beneficiaries navigate the options available in our area. Advertising during the Annual Open Enrollment Period can be confusing, misleading and sometimes downright fraudulent. Medicare counselors with the SHIP program can provide benefits explanations and plan comparisons for all of the Medicare Part D and Medicare Advantage Plans available in Southwest Utah and help determine which plans are best for you. Counselors will visit Senior Centers all across Southwest Utah to provide free, unbiased plan comparisons. In addition, one-on-one counseling is available in person, over the phone or on Zoom by appointment.
To have a Medicare Counselor complete a plans comparison with you, contact:
AAA-Five County Cedar City Office or Virtual Appointment: Amy (435)867-6020
AAA-Five County St. George Office: Tom (435)-673-3548
Or join us at your local Senior Center:
Beaver Senior Center Monday October 31 3:30 PM
Milford Senior Center Thursday, November 3 3:30 PM
Escalante Senior Center Friday November 4 12:00
Panguitch Senior Center Thursday November 3
Kanab Senior Center Wednesday November 2 11 AM
Long Valley Senior Center Wednesday November 2 11 AM
Cedar City Senior Center Wednesday November 16 12 PM
Parowan Senior Center Thursday November 4 12PM
Hurricane Senior Center Monday October 31 11:15 AM
Enterprise Senior Center Tuesday November 1
St. George Senior Center Tuesday November 1 11AM
During Open Enrollment, there is a higher risk than usual for fraudulent activities. Medicare has rules about how plans can and cannot communicate with you during Medicare’s Open Enrollment Period to market their insurance products. Knowing how to protect yourself from, detect, and report marketing violations can help save both you and Medicare money. Plans are allowed to send you emails and/or direct mailings, but they are not allowed to call you or visit you in person to market their products without your permission. Plans who send emails must provide an opt-out option for people who no longer wish to receive them. Watch out for people who:
· Pressure you to join their plan
· Tell you they represent Medicare and want to offer you a service for free
· Call you or visit your house without your permission to offer services or equipment
· Offer free consultations only to people with Medicare and ask for your Medicare number
· Inform you that you will lose your Medicare benefits unless you sign up for a certain plan
· Require you to provide contact information at an event for a plan (Note that contact information provided for raffles or drawings may only be used for that purpose)
Before you enroll in a plan, make sure you understand what the plan covers, how it affects your Medicare benefits and other health benefits (like Medicaid or your retiree/union coverage), and whether it covers the drugs you need. An agent or broker should never pressure you to join a plan. If you feel an insurance agent has violated Medicare’s marketing rules, you should save all documents (such as an agent's business card or marketing materials) or other suspicious information, such as recorded messages, and contact your local Senior Medicare Patrol (SMP). Your SMP can help you identify and report marketing violations, as well as other forms of Medicare fraud and abuse.
Amy Brinkerhoff has worked for the Five County Association of Governments for over ten years. She graduated from Brigham Young University with a degree in Sociology. Amy has been a SHIP counselor since her first week at Five County and now serves as Coordinator for the SHIP and SMP programs, where she offers one-on-one Medicare Counseling and teaches classes on Medicare topics and Fraud prevention.