What to Know for Medicare Open Enrollment

Every year, Medicare’s Open Enrollment period runs from October 15 to December 7. As a caregiver, you undoubtedly know how important insurance coverage is to securing your loved one the affordable care they need when they need it. What can be less certain, however, is knowing which exact program and options your loved one is qualified for and would most benefit from. As much as you want to help them through the process of enrolling in Medicare, you may be struggling to understand it yourself. The good news is that by learning the various benefits covered by different plans, you can put yourself in a better position to care for your loved one’s health needs and find the right plan for them.

“What is the difference between Medicare and Medicaid?”

One of the first questions caregivers and older adults often have at the start of the Medicare Open Enrollment process is “What is the difference between Medicaid and Medicare?” Here is a simple breakdown:

Medicaid	Medicare
Funded by the states and federal government. Administered by states. Rules vary state by state. Serves people who are legally blind, or disabled, as well as families, children, and pregnant women. Provides health coverage for those on a low income, regardless of age.	Funded by the federal government. Administered by the Centers for Medicare & Medicaid Services (CMS). Rules are the same nationwide. Serves people who are 65+, legally blind, disabled, or diagnosed with End Stage Renal Disease (ESRD). Provides health coverage regardless of income.

It may happen that your loved one might qualify for both Medicaid and Medicare based on their income, which is known as dual eligibility. If so, Medicaid and Medicare will work together to provide coverage at lower costs.

“What are the different options of Medicare?”

There are two main options for Medicare, Original Medicare and Medicare Advantage, which include four different parts. Here is a simple breakdown of the options:

Option 1

Option 2

Original Medicare
1.Part A (Hospital)
2.Part B (Medical)

Secondary Insurance
Group Health Insurance,
MedSup, or Medicaid

Prescription Coverage
Part D or Group Health
Insurance

Medicare Advantage
(Part C)
1. Hospitalization
2. Medical
3. Prescriptions (Medicare Advantage Prescription Drug Plans)

To understand these two options, it’s important to understand the different parts they are composed of: Medicare A, B, C and D:

Original Medicare:

Medicare Part A (hospital insurance): This covers inpatient hospital care, skilled nursing facility stays, hospice and some aspects of home health care.
Medicare Part B (doctor’s services): This covers doctor’s appointments, outpatient care in a hospital setting, some home health care, durable medical equipment and preventive screenings.
Medicare Part D (Prescription Drug Plan) offers prescription drug coverage to everyone with Medicare.

Medicare Advantage Plan:

Medicare Part C (Medicare Advantage Plans): These are plans sold by private insurance companies. These plans must offer at least the same level of coverage as Medicare Part A and Part B, but may also include prescription drug coverage, routine vision, dental and/or hearing benefits. When enrolled in a Medicare Advantage plan, your loved one continues paying their Part B premium, as they remain enrolled in Medicare Part A and Part B.

“When can I join or switch to Medicare drug plan?”

Open Enrollment is between October 15 and December 7, and the change will take effect in January as long as you enroll by the deadline. You can also join or switch:

When you’re first eligible for Medicare, during the 7-month initial enrollment period that begins 3 months before the month you turn 65, the month of your birthday, and 3 months after the month you turn 65.
If you qualify for Medicare due to a disability, during the 7-month period that begins 3 months before your 25th month of disability benefits and ends 3 months after your 25th month of disability.
During a Special Enrollment Period, including after:
- Moving out of your plan’s service area
- Moving to a care facility
- Enrolling in Medicaid
- Losing coverage from an employer or retirement plan
Once per calendar quarter, if you qualify for Extra Help. Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs. You may qualify for Extra Help, also called the low-income subsidy (LIS), if your yearly income and total resources are below these limits in 2020:
- Single person:
  - Income less than $1,615/month, and
  - Total resources less than $14,610.
- Married person living with a spouse and no other dependents:
  - Income less than $2,175/month, and
  - Total resources less than $29,160.

“Where can I turn for help?”

If you have further questions, do not hesitate to reach out to an official Medicare representative at 1-800-633-4227. Local financial counseling programs ESOP Cleveland, a subsidiary of Benjamin Rose Institute on Aging, can also assist you through the enrollment process.