Every year, Medicare beneficiaries can make changes in their Medicare coverage in the fall. This AEP allows beneficiaries enrolled in Original Medicare or any other Medicare plan to take control of their healthcare. This refresher will help remind beneficiaries how Original Medicare works and the importance of choosing the right Medicare plan.
A Look at Original Medicare
When someone refers to Original Medicare, they are talking about Medicare Part A and Part B. These parts of Medicare cover your medically needed medical services. While Medicare does have four parts, only the combination of A and B is considered Original Medicare.
While Original Medicare has some benefits, such as the freedom to choose any healthcare provider nationwide that accepts Medicare, fewer authorizations, and not requiring referrals to see specialists. However, there are some large drawbacks to staying only on Original Medicare, such as:
- No limit on how much you can spend
- No coverage for prescription medications filled at the pharmacy
- No coverage for anything not deemed medically necessary, such as dental, vision, or hearing coverage
Part A: Hospital Insurance
Medicare Part A covers hospital, hospice, and inpatient services. Beneficiaries pay a large per occurrence deductible when admitted to the hospital as an inpatient. Once the deductible is met, it covers all costs covered under Medicare Part A for the first 60 days(20 days if in skilled nursing). After that, there are additional costs.
Part B: Medical Insurance
Medicare Part B handles preventive care, outpatient medical services, prescriptions administered in an outpatient setting, and durable medical equipment. Medicare Part B has a small annual deductible. Once you meet your deductible, you must pay 20% of the Medicare-approved amount and up to a 15% excess charge.
Bridging the Coverage Gaps in Original Medicare
To help cover the cost gaps in Original Medicare, a few Medicare plan options offered by private companies are available to beneficiaries. To help offset these costs, individuals can enroll in a Medicare Advantage (Medicare Part C) plan, Medicare Supplement plan, and/or a Part D prescription drug coverage.
Exploring the role of Medigap (Medicare Supplement) plans
Medicare Supplement plans are standardized, except for three states Wisconsin, Minnesota, and Massachusetts. The coverage is identical regardless of your chosen insurance company. These plans are identified by letters; your chosen company and the monthly premium are the only difference.
These Medigap plans are secondary coverage, so they enjoy the same pros of staying with Original Medicare. However, for prescription drug coverage will need to enroll in a stand-alone Part D plan. These plans still only cover Original Medicare items, so items and services such as routine dental, vision, and hearing coverages aren’t included.
Some insurance companies provide discounts for some of these services for their enrollees.
Opting for Medicare Advantage (Part C) plans
Medicare Advantage plans are an alternative way to receive your Medicare benefits. These plan benefits will have varying costs and benefits depending on the location and plan you choose. While these Part C plans must cover everything Original Medicare does, they can include additional coverage and benefits.
Some of these benefits can include:
The drawbacks of these plans revolve around the networks. These plans are typically network-based, requiring you to use healthcare providers contracted with the plan. Some plans do allow out-of-network coverage but usually have a higher cost to using these non-network providers.
Enhancing Coverage with Part D
If a beneficiary stays with Original Medicare or adds a Medicare Supplement plan, it’s wise to add a Part D plan to cover prescription medications filled at the pharmacy. If you’re eligible for Medicare drug coverage and don’t enroll, you may be subject to a late enrollment period.
AEP 2023 Action Plan
As we approach AEP, it’s wise to have a plan of action. Review the annual notice of change from your current plan. Review your doctors and prescriptions to ensure they are still covered and affordable. Then review other plans that have the benefits you want and fit your needs and wants.
The best way to review plans is to speak with a licensed insurance agent. Find an agent with access to multiple companies to ensure you get someone looking out for your best interest. Insurance agents that specialize in Medicare will have tools that can be used to compare the plans side by side and check your healthcare providers, and drugs to see which plans fit your needs and wants in an easy-to-decipher snapshot.
Original Medicare & AEP FAQs
Can you return to your Original Medicare from an Advantage plan in AEP?
You can drop a Medicare Advantage plan and return to Original Medicare during a valid enrollment period. The most common is the Annual Enrollment Period. However, MA plans can be dropped if you qualify for a Special Enrollment Period (SEP) or during the Medicare Advantage Open Enrollment Period (MAOEP).
What is the difference between AEP and OEP in Medicare?
The AEP allows Medicare beneficiaries to make any changes to their Medicare coverage. The OEP allows beneficiaries enrolled in a Medicare Advantage plan to make one change to either a new Medicare Advantage plan, drop the Medicare Advantage plan and return to Original Medicare, or return to Original Medicare and enroll in a Part D plan.
How many changes can you make to your Original Medicare during AEP?
You can make as many changes as you want during the Annual Enrollment Period. However, the last plan chosen before the end of AEP (December 7) will begin on January 1.
Is the AEP the same as the OEP?
No. The AEP allows all Medicare beneficiaries to make changes to their plans. The OEP only allows beneficiaries enrolled in Medicare Advantage plans to make a change.
Get help with finding the right Medicare plan option for you
Finding the right Medicare plan in AEP to enhance your Original Medicare is paramount for a quality healthcare experience. Review plans in your area, and speak with a licensed professional to help answer any questions.
- AEP 2023: Understanding your rights
- Important Tips to Consider as You Approach AEP 2023
- AEP 2023 Medicare Plan Options
- Medicare Advantage Satisfaction Survey Results
- Medicare Satisfaction Survey Results for 2022
- Medigap vs Medicare Advantage Comparison
- Medicare Advantage Refresher for AEP 2023
- Refresher for Navigating Medicare Supplement During AEP 2023
- How the Medicare Part D 2024 Changes Will Impact Beneficiaries
- Shining Light on Medicare Star Ratings
- Understanding Medicare Costs: Your Comprehensive Guide
- Choosing the Right Medicare Plan in AEP