Do you have Medicare? Open enrollment season is HERE! Here’s what you need to know.

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SHINE Notice!

Please be advised that as of October 25, 2024, the Barnstable County SHINE program has reached capacity, and we are unable to schedule appointments.  

If you have questions about United Health Care, please find information here. 

If you have questions about Blue Cross and Blue Shield, please find information here. 

For Open Enrollment assistance please contact Medicare directly at 1-800-MEDICARE or visit them online at Medicare.gov. 

For MassHealth related matters, please call (800) 841-2900. 

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Medicare Open Enrollment is October 15 – December 7, 2024

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It’s officially Medicare Open Enrollment season! Read below for tips and resources to help you feel less overwhelmed and more in control of your decisions during this time.

Included in this post:

What IS open enrollment and where do I start?

Open Enrollment is the time to review your Medicare health or drug coverage and decide if you want to make changes. Remember, Medicare costs, benefits, and providers can change each year. Comparing your options could help you find better coverage or save money. The timeframe for Open Enrollment is October 15th through December 7th.

Resource 1: Watch this video entitled Medicare Open Enrollment – See the Difference. The brief video explains the importance of understanding your current plan and determining whether there might be ways to adjust your healthcare benefit to better fit your needs and/or reduce your costs for the upcoming year.

Resource 2: Take a first look at what’s new in Medicare in 2025 to help you manage your overall health and wellness. We’ll be getting into some of the specifics of this important guide (entitled Your Yearly Medicare Review) during our countdown.

Around Open Enrollment, you might get a lot of mail from companies offering Medicare products. Remember, Medicare.gov, the “Medicare & You” handbook, and 1-800-MEDICARE (1-800-633-4227) are your official sources of unbiased Medicare information.

Check your mail and review your information!

It’s important to review any information you get from your current plan, including the “Annual Notice of Change” letter, to learn how costs and benefits may change in 2025.

Resource 3: Look for a list of plans in your area. You can find this by visiting Medicare.gov/plan-compare, and in the most recent version of your “Medicare & You” handbook (which we mentioned above). You may be able to find plans in your area that:

• Cost less
• Cover your prescription drugs
• Have the providers you want, like your doctor or pharmacy, in their networks
• Offer some extra benefits that matter to you

Resource 4: Learn how to recognize what’s junk mail and what’s not to save you time and give you peace of mind. Visit: Junk or Not? How to Sort Your Medicare Mail (ncoa.org).

Have a disability? Get a BenefitsCheckUp®!

BenefitsCheckUp® connects millions of older adults and people with disabilities with benefits programs that can help pay for health care, medicine, food, utilities, and more. Simply visit the BenefitsCheckUp® website and enter your zipcode.

Know the difference between Original Medicare (also known as Part A and Part B) and Medicare Advantage (also known as Part C).

There are two types of Medicare: 1. Original Medicare and 2. Medicare Advantage. Why?

Simply put, Medicare Advantage was introduced to offer broader coverage options and give beneficiaries a more convenient, single-plan solution. It combines the coverage of Original Medicare with additional benefits, giving consumers more choices while helping to control costs within the Medicare system. Instead of just the standard, one-size-fits-all Medicare plan, Medicare Advantage allows beneficiaries to choose between a variety of private plans with different benefits, premiums, and provider networks; flexibility that allows consumer choices and best fits for individual health and financial situations.

In comparison, Original Medicare is generally considered simpler because it’s consistent, with fewer choices to navigate, no network restrictions, and predictable coverage.

Choosing between Original Medicare and Medicare Advantage depends on your personal healthcare needs, budget, and how much flexibility you want with provider choice.

Check out the following article from AARP to learn more: The Big Choice: Original Medicare vs. Medicare Advantage (aarp.org)

Medicare Parts A, B, C, and D Explained

Medicare can seem overwhelmingly complicated, especially since it has four different types of coverage – A, B, C, and D. Let’s break it down.

Medicare Part	What does it cover?	Key Costs
Part A	– Hospital stays – Skilled nursing – Hospice – Home care	Usually no premium, deductibles apply
Part B	– Doctor visits – Outpatient services – Preventative care	Monthly premium, plus a 20% co-insurance
Part C	Medicare Advantage (Parts A, B + Extras like dental, vision and drug coverage)	Varies by plan (premiums, co-pays)
Part D	Prescription drug coverage	Monthly premium, varies by drug and plan

Medicare Parts A and B form the foundation of what we refer to as “Original Medicare” and generally come together when a person turns 65 and enrolls in Medicare. Enrollment in Part A is usually automatic and premium-free, while Part B has a premium and can be declined if you have other coverage.

Medicare Part C, Medicare Advantage allows you to customize your benefit outside of Original Medicare. It’s offered by private insurance companies that approved by Medicare. These plans must cover everything that Original Medicare (Parts A and B) covers, but include additional benefits like dental, vision, hearing, and prescription drugs. Most Medicare Advantage plans also include Part D (prescription drug coverage, and extras like dental, vision and hearing).

Medicare Part D is prescription drug coverage. It helps to cover the cost of prescription drugs and commonly used medications. Each plan has a list of covered drugs that are grouped into different “tiers” that affect cost. Part D, which is offered by private insurance companies approved by Medicare, is available as a standalone prescription drug plan for people who have Original Medicare. Medicare Advantage plans (Part C) often include prescription drug coverage as a part of the plan*.

*If you are in a Medicare Advantage plan that doesn’t include drug coverage, you usually can’t buy a separate Part D plan, so you would need to either switch to a Medicare Advantage plan with drug coverage or switch back to Original Medicare and get a standalone Part D plan.

The table and explanations above are summaries of the differences between Medicare Parts A, B, C, and D, but there are many other more detailed nuances between the parts. It is important to understand each part and how they work together. Refer to the resources listed below for more information.

Resource 6: AARP | Understanding Medicare’s Options: Parts A, B, C and D

Resource 7: Medicare.gov | Parts of Medicare

Resource 8: NCOA | Explore your Medicare Coverage Options

Medicare Supplement Insurance – Medigap

Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private insurance company to help pay your share of out-of-pocket costs (copayments, coinsurance, and deductibles) in Original Medicare.

You might be wondering about the difference between Medigap and Medicare Advantage (or Medicare Part C). Medigap works WITH Original Medicare, while Medicare Advantage REPLACES Original Medicare through a private plan. They cannot be used together.

The table below provides a breakdown of Original Medicare with Medigap, and Medicare Advantage. Each column provides the corresponding differences of each:

Medigap (Original Medicare Supplement)	Medicare Advantage (Original Medicare Replacement)
Covers gaps in Original Medicare (deductibles, coinsurance, copays).	All-in-one plan (hospital, medical, drug, and extra benefits)
Medigap can be used with any provider who accepts Medicare.	Medicare Advantage is restricted to network providers.
Higher premiums, lower out of pocket costs.	Lower premiums, higher out-of-pocket costs.
No extra benefits (in addition to what is already provided by Original Medicare).	Often includes dental, vision, hearing, and wellness benefits.
Protects from out-of-pocket costs.	There is an annual out-of-pocket maximum (for medical expenses).
There are no referrals or pre-authorizations required.	May require referrals and pre-authorizations.
Original Medicare with Medigap is best for people who want flexibility, minimal out-of-pocket costs, and no network restrictions.	Medicare Advantage is best for people who want lower premiums, extra benefits, and are ok with network limitations.

Please review the resource below to see how Medigap works in Massachusetts:

Resource 9: Medicare.gov | Medigap in Massachusetts | Medicare

Resource 10: Mass.gov | Medicare Supplement Plans Offered in Massachusetts 2024

Whether you choose Original Medicare, Original Medicare with Medigap, or Medicare Advantage depends on your individual healthcare needs. Want help sorting through everything? Schedule an appointment with a certified SHINE Counselor! Call us at 508-375-6762.

Extra Help

“Extra Help” is a Low-Income Subsidy (LIS) Medicare program to help people with limited income and resources pay Medicare drug coverage (Part D) costs. Some people qualify automatically for Extra Help, while others need to apply. For example, people who have Medicaid (MassHealth) or Supplemental Security Income (SSI) are automatically qualified for Extra Help.

You can apply for Extra Help through the Social Security Administration at Social Security (ssa.gov).

The Extra Help program can help pay these Medicare drug costs:

• Premium: a monthly amount you pay for coverage, whether you get services or not
• Deductible: an amount you have to pay for covered services and items each year before Medicare or your plan starts to pay
• Coinsurance: A percentage of the cost that you pay

If you get Extra Help in 2024, you’ll pay:

• $0 for your Medicare drug plan premium and deductible
• Up to $4.50 for each generic drug
• Up to $11.20 for each brand-name drug
• $0 for each covered drug once your total out-of-pocket drug costs (including
  certain payments made on your behalf, like through the Extra Help program) reach $8,000

You won’t have to pay a Part D late enrollment penalty (if you have one) while you get Extra Help.

To learn more about Extra Help, refer to the resources listed below.

Resource 11: Medicare.gov | Medicare Extra Help Program

Resource 12: Social Security Administration | Apply for Medicare Part D Extra Help program | SSA

Resource 13: National Council on Aging | How Medicare’s Part D Low Income Subsidy Works (ncoa.org)

Medicare Savings Programs (MSPs)

Medicare Savings Programs (MSPs) are state-administered programs that help people with limited income pay for Medicare Part A and/or Part B costs. MSPs focus on reducing Medicare premiums, deductibles, coinsurance, and copayments for medical services.

To find out if you can get help paying for Medicare costs in Massachusetts, refer to the following resources:

Resource 14: Mass.gov | Get Help Paying Medicare Costs

What’s Changing in 2025?

Check out this article about changes to Medicare in 2025! According to AARP, 2025 will have one of the biggest changes to the Medicare prescription drug program ever: In 2025, out-of-pocket costs for covered drugs will be limited to $2,000 annually. The new cap applies to stand-alone Part D and Medicare Advantage (MA) plans with drug coverage. But the change is rippling down to other costs and coverage.

Resource 14: AARP | 5 Tips for Navigating Medicare Open Enrollment in 2025 (aarp.org)

Explore your Medicare Coverage Options at Medicare.gov!

If you haven’t already, you should definitely set up an online account with Medicare.gov. You just need your Medicare Number and coverage start date, located on your Medicare Health Insurance Card. Don’t have a Medicare card? Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Once you’ve created an account, you’ll be able to see a summary of your current coverage, as well as any saved drugs and pharmacies. You’ll be able to compare plans in your area, find out what they cost, and the services they provide. You can also enter prescription drugs to get an estimate of your monthly and yearly cost for each plan.

Resource 18: Explore your Medicare coverage options

Choose Wisely and Remember, Last year Doesn’t Matter

Don’t assume something that was covered last year will continue to be. You have time (almost two months!) to assess your current coverage and see what changes are being made to the policy for the next plan year.

Since plans change from year to year, be sure to check that all your favorite doctors are still in-network if you have a Medicare Advantage and that your pharmacy locations are part of your Part D plan. If you aren’t happy with your current providers, you should look at whether you can improve your coverage, save money, or both, by switching up your policies

Source: Choose Wisely: Tips for Medicare Open Enrollment – Patient Advocate Foundation

Medicare Open Enrollment – Multilingual Resources

If you, or someone you’re helping, has questions about Medicare, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 1-800-MEDICARE (1-800-633-4227).

¡Medicare.gov está disponible en español!

• Inicie sesión o cree una cuenta
• Buscar planes de salud y de medicamentos
• Buscar proveedores de cuidado
• Hablar con alguien

Resource 19: Bienvenido a Medicare | Medicare

If you, or someone you’re helping, has questions about Medicare, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 1-800-MEDICARE (1-800-633-4227).

Português (Portuguese) Se você (ou alguém que você esteja ajudando) tiver dúvidas sobre a
Medicare, você tem o direito de obter ajuda e informações em seu idioma, gratuitamente. Para falar
com um intérprete, ligue para 1-800-MEDICARE (1-800-633-4227).

Kreyòl (Haitian Creole) Si oumenm oswa yon moun w ap ede, gen kesyon konsènan Medicare, se
dwa w pou jwenn èd ak enfòmasyon nan lang ou pale a, san pou pa peye pou sa. Pou w pale avèk yon
entèprèt, rele nan 1-800-MEDICARE (1-800-633-4227).

Resource 20: Looking for Help in Other Languages?

Beware of Medicare Fraud!

While evaluating your options for health care during Open Enrollment season, watch out for scammers targeting your money and personal information. Scammers often take advantage of people who have questions and concerns during open enrollment periods by trying to confuse or mislead them.

• Don’t answer calls from numbers you don’t recognize, even if the number in your caller ID appears to be local. If you do answer the phone, but you become suspicious that the call isn’t legitimate, don’t hang on, hang up.
• Take care in considering offers you receive by phone or text by checking the health-care company’s official web site. Using contact information there, contact the company to ask about the offer to make sure it’s legitimate.
• Decline promotional gifts in exchange for personal information. Beware of any “free” offers.
• Never give out personal information such as account numbers, Social Security numbers, Medicare ID numbers, mother’s maiden names, passwords, or other identifying information in response to unexpected calls or if you are at all suspicious.
• If you get an inquiry from someone who says they represent a healthcare company or a government agency, hang up and call the phone number on your account statement, in the phone book, or on the company’s or government agency’s website to verify the authenticity of the request.
• Contact legitimate health care insurance providers directly, using the customer service number on a billing statement or by finding a contact number on the provider’s website.

If you think that you’re a victim of a health care enrollment scam, you should first contact law enforcement to report it. You can also report it to the Federal Trade Commission at reportfraud.ftc.gov. You can file a complaint about phone scams with the FCC Consumer Complaint Center.

Resource 21: Health Care Scams Tend to Spike During Open Enrollment | Federal Communications Commission (fcc.gov)

Resource 22: AARP | Keep an eye out for scams during Medicare Open Enrollment (aarp.org)

Resource 23: Learn about Medicare prescription drug plan scams | Mass.gov

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