Transitioning from private insurance to Medicare? Here’s what to expect.

If you’re about to turn 65, you should know that employer-sponsored or private insurance is quite a bit different from Medicare. Now is a good time to take a few minutes to get acquainted with what to expect from Medicare.

Unlike private insurance companies, or employer-sponsored health plans, which usually offer a general enrollment period for all their members, Medicare has three different enrollment periods.

• Initial enrollment usually starts three months before your 65th birthday and ends three months after your 65th birthday, which gives you seven months to sign up.
• Annual enrollment period occurs yearly between Oct. 15 and Dec. 7. During this time, current Medicare users can enroll in a Medicare plan with or without prescription drug coverage.
• Open enrollment runs Jan. 1 to March 31. You can make one change from one Medicare Advantage plan to a Paramount Medicare Advantage plan if you would like to.

Additionally, there are special election periods which accommodate certain situations, for example, if you decide not to retire until after your 65th birthday.

Medicare Plan Choices

Even for the most decisive person, choosing a Medicare plan can be overwhelming. There are Medicare Advantage plans (Part C), Original Medicare (Parts A and B), prescription coverage (Part D) and Medicare Supplement (Medigap) plans. Plus, there are HMOs and PPOs. Learn more about the different types of Medicare and when you can enroll in this article.

Access To Doctors

If you’re currently covered by an employer-sponsored health plan, most likely you have access to a set network of doctors, hospitals and other providers. Medicare Advantage plans work the same way. However, with original Medicare and Medigap, you can see any provider who accepts Medicare.

So, why do so many people choose a Medicare Advantage plan that may limit their access to some providers? One reason is that health plans usually offer networks with high-quality doctors who can coordinate your care with other doctors in the same network. This creates a more seamless experience for you and positive outcomes for your health. Some plans even allow you to go out-of-network with prior approval.

Cost

If you choose a Medicare Advantage plan, or a Part D plan for prescription coverage or Medigap, you will likely have a monthly premium to pay, in addition to your Part B premium. Medicare Advantage and some Part D plans allow you to deduct your premium from your Social Security check.

Like employer-sponsored plans, Medicare Advantage plans place a cap on how much you’ll pay each year. Original Medicare does not. You’ll want to carefully investigate deductibles, coinsurance and how much you think your yearly medical costs will be.

Another difference? Medicare Part B caps how much they will pay for your prescriptions. With an employer-sponsored plan, you only pay the prescription copay each time. With Medicare, when you reach the cap for copays, you fall into a gap, where you pay the full cost of the drug.

As you can see, finding the right Medicare plan for your specific needs takes a lot of consideration. That’s why we recommend dedicating time before your 65^th birthday to review your health plan options and find a local and trusted Medicare expert who can help you on your journey.

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