Medicare open enrollment is here, running from October 15 through December 7. If you or a loved one qualifies for Medicare, this is your opportunity to review available healthcare coverage and choose a plan. Understanding your options will help you choose the plan that best meets your health and financial needs.

 What Are My Medicare Options?

Original Medicare is the traditional health plan provided by the federal government. It consists of two parts:

• Part A (Hospital Insurance): Covers inpatient hospital care and skilled nursing facility services.
• Part B (Medical Insurance): Covers physician services, outpatient care, and preventive services.

With Original Medicare, you can visit any healthcare provider who accepts Medicare, offering flexibility when choosing your doctors and hospitals. There is also an option to enroll in add-on programs like Medigap that cover additional costs, or Medicare Part D prescription plans.

Medicare Advantage (Part C) is an alternative to Original Medicare, offered by private insurance companies. It replaces both Part A and Part B and some plans also offer additional benefits like vision, dental, and fitness programs.

Which Medicare Plan is Right for Me?

While Medicare Advantage plans can seem appealing with lower monthly premiums and copays, they often require you to use a set network of providers, strictly limiting options for care in rural areas. Prior authorization is often required for many services, and there are limitations to the doctors and specialists you can see.

Advantages of Original Medicare:

• Broad Access: You can see any doctor or specialist who accepts Medicare, which is especially important in rural areas where access to healthcare providers may be limited.
• No Network Restrictions: Original Medicare offers more flexibility, as you are not restricted to a network of providers.
• No Prior Authorizations Required: Original Medicare does not require approval before receiving care, making it easier to access the services you need.

Disadvantages of Original Medicare:

• Higher Out-of-Pocket Costs: Without a supplemental Medigap or prescription plan, you may face higher copays and deductibles.
• Lack of Additional Benefits: Original Medicare typically does not cover dental, vision or fitness services.

Advantages of Medicare Advantage:

• Lower Monthly Costs: Medicare Advantage plans often have lower premiums and out-of-pocket costs compared to Original Medicare.
• Extra Benefits: Some plans include additional services like dental, vision, and wellness programs.
• All-in-One Plan: Medicare Advantage often bundles Parts A, B, and D into one plan, which can simplify your coverage.

Disadvantages of Medicare Advantage:

• Network Limitations: Medicare Advantage plans typically require you to use a specific network of providers, which can be restrictive, particularly in rural areas. In fact, a recent study from the Kaiser Family Foundation found that rural residents enrolled in Medicare Advantage plans are nearly twice as likely to switch back to Original Medicare due to limited provider networks.
• Prior Authorizations: Nearly all Medicare Advantage plans require prior authorization for services, which may delay or limit access to care.
• Potential for Higher Costs: Some people with Medicare Advantage end up paying more for hospital stays or treatments than they would with Original Medicare, especially if they have significant health issues.

Before you decide on a plan during open enrollment, check with your insurance provider to ensure that your plan will be available in your area, as many providers have changed or ended coverage in certain counties, specifically rural counties like ours. If you’re renewing or switching plans, make sure your selected plan will cover you locally.

Still Undecided?

Making the right choice between Original Medicare and Medicare Advantage can be challenging, but you don’t have to navigate it alone. Contact your healthcare provider or Senior Health Insurance Counseling for Kansas (SHICK) for personalized assistance.

For more information, visit the SHICK website or call (800) 860-5260 to speak with a local coordinator.

Medicare Open Enrollment is from Oct. 15 to Dec. 7. Be sure to review your options carefully before making any changes to your coverage.