Medicare Open Enrollment 101: Everything You Need to Know


Medicare open enrollment for 2022 launches October 15 and wraps up on December 7. Anyone old enough to qualify for Medicare likely has been inundated with advertisements touting the benefits of the numerous options available.


Signing up for the first time can be intimidating and overwhelming. Even if you already are enrolled in the program, making changes can be confusing and complicated without someone to guide you.


Working with an authorized Medicare insurance agency can help enrollees sort through the endless choices. Three agents covering seniors in the North Hills offered valuable tips and tools for navigating through open enrollment.


Working with an Insurance Broker

This was the number one piece of advice every insurance agent recommended. It does not cost any extra to consult with these knowledgeable Medicare insurance brokers and can save you a lot of time and hassle finding the best coverage for your needs.


“When you work with an insurance broker, they can review your medical history and other factors, then recommend the plans that are right for you,” said Kim Santillo, a licensed Medicare and insurance agent. “You can enroll for Medicare on your own, but there is no charge to go through an agent or broker, so it’s to your benefit to work with someone.”


Tim Powers, an insurance representative with Health Markets, suggested working with an agent like himself who represents all of the plans, so you have access to every available option.

Medicare Advantage vs. Medigap

One of the options you have when enrolling in Medicare is choosing between Medicare Advantage and Medigap coverage. Both Medicare Advantage and Medigap fill the “gaps” in coverage with Original Medicare.


Medicare Advantage comes with all the same perks as Original Medicare, plus some extras like dental, hearing, and vision coverage. You are never excluded from Medicare Advantage when you have a pre-existing condition, and Advantage plans can be beneficial when funds are tight, for example, for seniors on fixed incomes.


Unlike Medicare Advantage and Original Medicare, Medigap plans can be changed at any time during the coverage year without penalty. You do not need to wait for open enrollment.

“They may require medical underwriting if you are outside of your initial enrollment period, which is six months after you enroll into Part B of Medicare,” warned Wayne Alling of the Alling Agency. “Medigap coverage does not include prescription drugs, so Medicare beneficiaries must evaluate these options to not incur a penalty later on.”


Tips for First-timers

Anyone signing up for the first time may feel overwhelmed and outright confused about their options. Medicare is a complex insurance program. Working with an insurance representative who understands the ins and outs of Medicare can help first-timers.


“For anyone signing up for the first time, it is important to take due time to understand how Original Medicare works and when you should enroll, how much it is going to cost you, and what option is best for your specific situation,” said Alling. “I always recommend starting the conversation on Medicare six months prior to your 65th birthday.


“It is also important to speak with a broker or someone who represents many different plan options,” he added. “This will allow you to evaluate all of your options, not just the one or two offered by individual insurance carriers.”


Powers said part of narrowing down options involves exploring the different components of each plan and your financial obligations and contributions with each of them. Base Medicare covers only 80 percent of medical costs, leaving individuals to pay for the remaining 20 percent. That can become a costly venture when hospital stays, or other advanced treatments, are involved in your medical care.


Santillo suggests including Medigap coverage when you first enroll for Medicare. If you sign up for it during your introductory enrollment, you avoid future medical underwriting or denial of coverage. With Medigap, if you wait to add it until later years, you can be turned down for coverage or given higher premiums due to pre-existing conditions.


“I always recommend Medigap for clients with a lot of health issues,” she said.


Making Changes to Your Current Plan

Anyone unhappy with their current Medicare plan can make changes during open enrollment. Modifications can include buying more coverage for new health conditions or selecting options with lower copays or deductibles to fit your budget.


“New plans can become available and produce cost savings, so it is worth exploring your options every year,” said Powers. “This is where working with a Medicare insurance representative is to your advantage. They can review your case throughout the year and make recommendations for plans that accommodate health or financial changes.”

Additional assistance about Medicare is available on www.Medicare.gov.

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