Navigate Medicare Open Enrollment with confidence this year.

This overview will help you make informed decisions to optimize your Medicare coverage.

If you are already entitled to Medicare, open enrollment is currently underway. You have until December 7th to review, switch, or make any changes to your upcoming year of health care coverage. When considering what coverage best meets your needs, I always recommend seeking out recommendations from a source that is not invested in selling you their product.

• Medicare.gov Guidance:

Medicare.gov provides free accurate guidance. Visit their page for tools to help guide you to plans that best fit your needs. This includes a user-friendly ‘compare coverage options’:

https://www.medicare.gov/health-drug-plans/open-enrollment.

• State Health Insurance Assistance

Program (SHIP): Another trusted source I have recommended is your SHIP, found at https://www.shiphelp.org/. You can put in your zip code and receive local coverage answers from Medicare experts who are there to help you find the coverage that works best for you. Crucially, these experts are independent of specific insurance sources.

Don’t have Medicare coverage yet?

If you are insured for Title II or railroad benefits, you become eligible for Medicare at the attainment of age 65 or your 25th month of entitlement to disability.

Other special provisions are available for individuals who have end-stage renal disease and Amyotrophic Lateral Sclerosis (ALS). Qualified Medicare Beneficiary (QMB) provisions are also available for those that are uninsured for Medicare. Remember, all factors of entitlement must be met before entitlement can begin for any Medicare coverage.

Over 65 and not sure you want to take Medicare yet?

There are three standard enrollment options available to you: initial, general, and special enrollment periods.
The most common circumstance if you are over age 65 and haven’t taken your Medicare Part A or B yet is that you or your spouse are continuing to work and you maintain active health insurance coverage based on that continued employment. In this instance, it is common for an applicant to file for a Medicare Part A only application. This is accomplished by restricting the online application to Medicare only and provides you with additional hospital insurance at no cost to you.

Entitlement Considerations:

1. Health Saving Account (HSA) Impact: Be aware that if you are participating in a Health Saving Account (HSA), entitlement to Part A does impact that coverage. Part A coverage start date is controlled by your date of filing, not your month of entitlement, and affords six months retroactive coverage. This retroactive coverage is not optional and cannot be waived or changed. You can get details on how the HSA is affected by Part A from your insurance carrier or tax professional.

2. Spousal Entitlement: If you aren’t insured on your own earnings record, there is also a special provision for technical entitlement on your spouse’s earnings record. As long as your spouse is eligible for benefits, you can claim your Medicare entitlement on their earnings record. They need only to be eligible for benefits; they are not required to have filed.

As always, know your rights, ask the Social Security Administration (SSA) directly for guidance, or consult a certified SSA professional.

Maryellen Eckert EDPNA