Ezratty: Medicare questions and answers for the Sun Cities
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By Roberta Ezratty
Question: I hear people talking about Medicare Open Enrollment. I am over 65 and enrolled in a Medicare Advantage Plan. Do I have to re-enroll for 2021?
Answer: No, you do not need to enroll. It is a good idea to explore available Advantage plans and compare their offerings with what you currently have. Every year, between Oct. 15 and Dec. 7 Medicare offers the annual open enrollment for Medicare Advantage plans and Part D Drug plans. Some things to compare in 2021 Advantage plans are copays, total out of pocket expense, drug coverage, dental and vision coverage, names of doctors in the plan, as well as other perks.
Original Medicare covers most medically necessary services for approximately 80%; many preventive services are covered in full. The foundation of your health care is Medicare. To help pay the 20% out of pocket cost, you have three options. One is to enroll in a Medicare Advantage Plan, which assumes your Medicare health risk and pays your medical claims minus applicable co-payments in the county where you primarily reside. This is a Health Maintenance Organization plan, which is paid for in part by Medicare; and covers doctors, labs, x-rays, emergency services, Medicare Part D drug plan, and many “perks,” such as dental, vision, fitness centers, etc. In Maricopa County almost all Advantage plans have no monthly premium. Each plan has its own copay rates and perks.
The second option is to enroll in a Medigap — also called supplemental — plan that differs from Advantage (HMO) plans because you pay a monthly premium, but you have the freedom to choose your own doctors, even out of state, and pay a small or no out of pocket costs. Some feel the cost of a monthly premium is worth having the freedom and the annual health care cost predictability. Medigap plans do not cover Part D (drugs) or have dental or vision.
The annual open enrollment period is the time to check your current Medicare Advantage plan, compare it with similar plans and make changes if you wish. For people who do not have a Medicare Advantage plan, this is the time to compare your current drug plan with other 2021 drug plans.
For individual free consultations with your SHIP counselor, please call 623-866-4214.
Editor’s Note: Ms. Ezratty is a certified State Health Insurance Assistance counselor. She provides question and answer information about Medicare during the open enrollment period.
