Diagram of medicare

Once a year, an important window of opportunity arrives for Medicare beneficiaries and those about to enroll in the government’s health insurance program for older Americans.

It’s the Medicare open enrollment period, which runs annually from Oct. 15 to Dec. 7. During those nearly two months, new enrollments are allowed and current recipients can make changes to their plans.

And it’s definitely not a period to be taken lightly because careful study is required to determine what Medicare plan is best for any individual, says Chris Orestis, the president of LifeCare Xchange who is known as the “Retirement Genius” (www.retirementgenius.com).

“Enrolling in Medicare can be complicated, and if you don’t pay attention you can end up missing needed coverage or paying more out-of-pocket expenses in premiums, co-pays and deductibles than you realize-- or can afford,” Orestis says.

About 68 million Americans are enrolled in Medicare, according to the Kaiser Family Foundation. Here are a few important facts to know for anyone ready to enroll and join them, or who needs to change their plan:

• Medicare coverage comes in two primary forms that participants can choose from, Orestis says. The original and traditional Medicare program is  administered through the federal government and anyone 65 and older qualifies automatically. Meanwhile, there are Medicare Advantage plans that are sold by private insurance companies. Those have become increasingly popular, with more than one-third of all Medicare beneficiaries enrolled in one. Beyond the usual things covered by health insurance, the Advantage plans sometimes offer additional services, such as routine vision, hearing and dental care.

• If things aren’t bewildering enough, it’s also important to understand what Medicare Parts A, B, C and D are and what each does, Orestis says. “Here’s how that alphabet soup of Medicare coverage breaks down,” he says.”Medicare Part A pays for hospital and skilled nursing facility care. Medicare Part B pays 80 percent of costs for doctors, outpatient services and medical equipment. Medicare Part C is a private Advantage Plan. Medicare Part D pays for prescriptions.”

• Even with Medicare coverage, patients can still have deductibles and copays that can add up quickly. “That’s where Medicare Supplement Insurance (Medigap) comes in,” Orestis says. “It’s a private insurance that pays the gaps in the varieties of Medicare coverage.”

Still confused? Not to worry. Assistance is available to help people understand and navigate enrollment, Orestis says. Insurance agents who specialize in Medigap and Medicare Advantage Plans can help with initial enrollment and open enrollment.

Free assistance can also be obtained through the State Health Insurance Assistance Program (SHIP) and the Medicare Rights Center. Also, the Center for Medicare and Medicaid Services (CMS) which is the government agency that administers both Medicare and Medicaid, provides a wealth of information and resources to review and assist enrollment on their website, Orestis says.

“When it comes to Medicare enrollment, don’t procrastinate,” he says. “Not being informed, missing deadlines, or making the wrong selections can cause delays and penalties that could have a negative impact on your coverage – and your wallet.”

Chris Orestis, known as the “Retirement Genius” (www.retirementgenius.com), is President of LifeCare Xchange and a nationally recognized healthcare expert.

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