If you or a loved one will soon be eligible for Medicare, join us for this Medicare Minute! We’ll go over all the basics you should know—from enrollment periods to coverage choices and beyond.

Some people are automatically enrolled in Medicare. For example, if you are already receiving retirement benefits from Social Security when you become Medicare-eligible, or if you’ve been collecting Social Security Disability Insurance for two years. If you are automatically enrolled, you should receive a package in the mail with your Medicare insurance card telling you so. Otherwise, there are three times to enroll in Parts A and B:

Initial Enrollment Period (IEP): The three months before, the month of, and the three months after your 65^th birthday.

Special Enrollment Period (SEP): Allows you to delay Medicare enrollment without owing a late enrollment penalty. You may qualify for an SEP if:

• You or your spouse (or sometimes another family member) are still working, and you are covered by the employer health insurance. Note that you shouldn’t delay Medicare enrollment if this employer coverage pays secondary to Medicare.
• You have experienced other exceptional circumstances, like losing Medicaid coverage, being released from incarceration, being misinformed by an employer, or being impacted by an emergency or disaster.

General Enrollment Period (GEP): Every year from January 1 through March 31. You may owe a late enrollment penalty and face gaps in coverage if you use the GEP.

Download the full “New to Medicare” handout by the State Health Insurance Assistance Program (SHIP). 

The Medicare Rights Center is the author of portions of the content in these materials but is not responsible for any content not authored by the Medicare Rights Center. This document was supported, in part, by grant numbers 90SATC0002 and 90MPRC0002 from the Administration for Community Living (ACL), Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy. [April 2024]

Many people assume that their family members would automatically be able to make decisions about medical treatments if they were to become incapacitated. However, rules vary greatly from state to state:

• Your family may have to go through a costly and time-consuming court process to get the legal right to make medical decisions for you.
• Your family members may disagree on who should make medical decisions on your behalf, which could lead to legal disputes.
• Someone unfamiliar with your preferences may be placed in charge of your treatment choices.

It’s important to have a plan ahead of time to avoid disagreements around treatment issues and to ensure your wishes are honored if you are incapacitated. Advance directives, living wills, health care proxies, and powers of attorney can help ensure that decisions made on your behalf meet your needs and preferences.

Important documents to have include:

• Health care proxy – Names someone you trust as your proxy, or your  agent, to express your wishes and make health care decisions for you if you’re unable to speak for yourself.
• Living will – A written record of the type of medical care you would want in specified situations.
• Advance directive – Often refers to a combination including both a living will and health care proxy documents.
• Power of attorney – Names someone you trust as your agent to make property, financial, and other legal decisions on your behalf.

For detailed tips on preparing these documents download the “Preparing for Future Health Care Needs” handout by the Medicare Rights Center. 

To understand how Medicare covers hospice and for answers to other Medicare coverage questions, contact your State Health Insurance Assistance Program (SHIP). You can visit www.shiphelp.org or call your local SHINE Medicare Counselors at 1-866-413-5337. 

With a new year comes changes to your Medicare costs and coverage. Download this timely handout for details on changes in hospital insurance, medical insurance and prescription drug coverage. 

When can I change my coverage in 2024?

You may realize at some point in 2024 that you aren’t happy with your coverage. Many people may have to wait until the next Fall Open Enrollment Period (October 15 through December 7) to change their coverage. You may be eligible for other opportunities to change your coverage earlier in 2024, though:

• If you have a Medicare Advantage Plan: During the Medicare Advantage Open Enrollment Period (MA OEP), you can switch from your Medicare Advantage Plan to another Medicare Advantage Plan or to Original Medicare with or without a stand-alone prescription drug plan. The MA OEP occurs from January 1 through March 31. Changes made during this period are effective the first of the following month.
• If you qualify for a Special Enrollment Period (SEP): You may be able to make changes to your Medicare health/drug coverage depending on your circumstances. For example, you may have an SEP if you move outside of your plan’s service area or if you made the wrong plan choice during Medicare’s Open Enrollment Period because of misinformation you received. Call 1-800-MEDICARE to use an SEP. For questions about SEPs, contact your State Health Insurance Assistance Program (SHIP) by calling 877-839-2675 or visiting shiphelp.org.
• If you have Extra Help: You have an SEP to enroll in a Part D plan or switch between plans. This SEP is available once per calendar quarter for the first three quarters of the year (January-March, April-June, and July-September). If you use the Extra Help SEP to change your coverage, the change will become effective the following month.

If you have a Medicare Advantage Plan, contact your plan directly to learn about your 2024 costs.

“New” Medicare card schemes

Do you know what isn’t new this year? Your Medicare card.

Medicare beneficiaries are not receiving new cards this year, but scammers may try to convince you otherwise. For example, scammers may falsely tell you that Medicare is issuing new cards—perhaps a card that is plastic or metal, or a card that has a chip in it. The scammers may tell you that for them to send your new card, you need to verify your identity, which could include your Medicare number. This is an attempt to get your personal or financial information.

Here are some red flags to look for:

• Unsolicited calls from anyone claiming to be from Medicare

• Anyone needing your personal information so that they can send you an updated Medicare card

• Anyone saying your card is expiring, and they need to send you a new one or you will be charged a fine

• Anyone stating Medicare is issuing new cards and you need to verify your number

Have questions? Call our SHINE Medicare counselors at 1-866-413-5337 or email shineinfo@aaaswfl.org.

Depending on your coverage, you will have different considerations when choosing health care providers like doctors, hospitals, or medical equipment suppliers. Follow this link to review some of these factors, so you can get your care covered at the lowest cost. 

Even with this information in hand, remember to trust yourself and your feelings when choosing your health care providers. For instance, just because a provider is in network doesn’t mean they will be a good fit for you. You may have to try multiple providers before finding one who you trust and who fits your needs.

If you have Original Medicare, choose a participating provider.

There are three types of providers, and each has a different relationship with Medicare. To pay the least for your care, see a participating provider when possible.

Participating providers accept Medicare and always take assignment. Taking assignment means that the provider accepts Medicare’s approved amount for health care services as full payment. Participating providers must submit a bill to Medicare when you receive care. Medicare then processes the bill and pays the provider 80% of the cost of your care. You are then responsible for the other 20% of the cost.

Non-participating providers, on the other hand, accept Medicare, but do not have to take assignment. This means they can charge up to 15% more than Medicare’s approved amount for services. In other words, you could owe up to 35% of the cost of Medicare’s approved amount for services instead of just 20%.

Opt-out providers do not accept Medicare at all. These providers have signed an agreement to be excluded from the Medicare program. Medicare will not pay for care you receive from an opt-out provider, except in emergencies, and will not reimburse you. These providers can charge whatever they want for services, following certain rules.

Choosing Doctors and Other Providers

If you have Medicare Advantage, choose an in-network provider.

A network is a group of doctors, hospitals, and medical facilities that contracts with a plan to provide services. Each type of Medicare Advantage Plan has different network rules. There are various ways a plan may manage your access to specialists or out-of-network providers. For example, if you see a provider who is outside your plan’s network, you may have to pay more than you would for an in-network provider. You could also be responsible for paying the full cost of your visit, depending on what type of Medicare Advantage Plan you have.

Remember that your costs are typically lowest when you use in-network providers and facilities, regardless of your plan type. It’s important to note that not all Medicare Advantage Plans work the same way. Make sure you understand a plan’s network and coverage rules before enrolling. If you have questions, contact your plan for more information.

If you have Part D, choose an in-network pharmacy and look for pharmacies with preferred cost sharing.

Part D plans generally have networks of pharmacies that they contract with to provide you with covered medications. Many pharmacy networks include pharmacies that offer lower “preferred” cost sharing. You typically pay less for your prescriptions at these pharmacies. If you need to find in-network pharmacy or if you have any issues accessing your covered medications at the pharmacy, contact your Part D plan.

Need help finding doctors and other providers?

• If you have Original Medicare: Call 1-800-MEDICARE (633-4227) or use Medicare’s online Care Compare tool.
• If you have Medicare Advantage: Contact your plan for a list of in-network providers.
• For more assistance, contact your State Health Insurance Assistance Program (SHIP). In Southwest Florida, that is SHINE (Serving Health Insurance Needs of Elders), call 1-866-413-5337 or email shineinfo@aaaswfl.org.

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