With Open Enrollment Coming to a Close, NJ Medicare Expert Answers Your Top Questions

 Hiram Bermudez

During each Medicare Annual Enrollment Period (AEP), which runs through December 7, seniors and those eligible for Medicare are often overwhelmed by the choices that flood their mailboxes and the airwaves.

That said, making sure that you or your parents have the best possible healthcare through Medicare is vitally important. If you have questions about which healthcare plan is right for you, how much it will cost, what’s covered, or just want to know if you can keep your doctor with a new plan, you aren’t alone.

As a seasoned Medicare broker and long-time employee of Clover Health, one of the fastest-growing Medicare Advantage plans in New Jersey, I’ve been asked these types of questions for the last 20 years. Here are my answers to some of your most common ones, written in plain English.

1. What is Medicare open enrollment?

Otherwise known as AEP, Medicare open enrollment is happening right now. From October 15 to December 7, millions of seniors have the power to choose the health plan that works best for them. During this window, those who already have original Medicare can easily switch to Medicare Advantage, or switch from one Medicare Advantage plan to another. You can also join, drop, or switch between Medicare Part D prescription drug plans, or get a supplemental policy. Any changes you make during this AEP are effective January 1, 2020.

1. What’s the difference between Medicare and Medicare Advantage?

Medicare Advantage, also known as Part C, is part of the official Medicare system, but offers significant added benefits. Beyond substantial hospital and doctor visit coverage, Medicare Advantage plans can also offer low premiums and a wealth of additional benefits—including prescription drug coverage, in-home checkups, vision, dental, and hearing care—not covered by traditional Medicare. These plans also protect members by having a cap on out of pocket costs (unlike traditional Medicare), which can provide important peace of mind for unanticipated major medical needs.

But here is the real reason why I think Medicare Advantage can have such a profound impact on healthcare—it’s about being cared for before you get sick. Studies show seniors enrolled in Advantage plans have one-third fewer emergency room visits and almost a quarter fewer hospital stays than those enrolled in traditional Medicare. With Medicare Advantage, there is a focus on preventative, total care, which is what seniors need most.

1. How do I know which plan is right for me?

When choosing a plan, it’s important to forecast what your care needs are for the next year. For instance, if you’re on traditional Medicare, and are suffering from chronic conditions that require regular specialist visits, or have an expensive surgery coming up, an Advantage plan will likely be the cheaper option. For those already in Medicare Advantage, perhaps your medicine co-payments are rising, or doctors have changed networks. Or, maybe there specific added benefits that you’d like access to—like a gym membership, telemedicine, or transportation to doctor’s appointments. In these cases, it might be time to look for another plan with different benefits.

Once you’ve landed on what budget and benefits are right for you, head to the Medicare Plan Finder, operated by the Centers for Medicare and Medicaid Services, a government agency. On the website, you can enter your prescriptions and shop around for personalized information about co-payments, premiums, and estimated out-of-pocket drug costs for the plans in your zip code area.

4. Can I still see my doctor on a Medicare Advantage plan?

This is a big one. If you’re on traditional Medicare, you can see any doctor that accepts Medicare. However, many Medicare Advantage plans have narrow and limited provider networks, which may require you to switch doctors, even if you’ve been going to the same one for years.

Clover is different. We believe in providing our members with choice and want our members to be able to go to any doctor who will accept our payments—we pride ourselves on offering a wide, open network for all of our PPO plans. If you have a doctor that works for you, and you like them, you should be able to keep seeing that doctor, regardless of changes to your insurance. Clover also offers HMO plans for seniors interested in that option.

5. How do I sign up?

Make sure you have your Red, White, and Blue Medicare card, issued by the Social Security Administration, and number on hand. Then, I’d recommend speaking with your local insurance broker to walk through the best options for you, based on your health and financial needs. Having a trusted guide throughout the process is key to making the best decision possible.

If you’d prefer to handle enrollment on your own, you can also sign up online through the Medicare Plan Finder portal or visit the specific company’s website.

If you’re interested in learning more about Clover Health, call us directly at 1-800-836-6890. We’d love to have you join us.

Hiram Bermudez is the Vice President of Sales for Clover Health.

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Disclaimer: Clover Health is a Preferred Provider Organization (PPO) plan and a Health Maintenance Organization (HMO) plan with a Medicare contract. Enrollment in Clover Health depends on contract renewal.