Answers to Questions about Enrolling in Medicare

By Gloria Paradiso

The Medicare annual enrollment period (Oct. 15 – Dec. 7) is when many individuals will make important Medicare plan choices regarding 2024 coverage. It’s crucial that Medicare-eligible individuals understand plan options and make informed choices for themselves and/or loved ones, because those who find coverage plans that meet their health and wellness needs are more likely to take advantage of their benefits and stay healthy in the long run.

Here are some of the most common questions and helpful answers about the Medicare enrollment process, what Medicare typically covers and what’s new for enrollees in 2024.

Q. Who are Medicare plans for?

Medicare is the federal health insurance program funded by the government that is available to those age 65 and over, or who have certain disabilities. There are generally two groups who are shopping for a plan: those who already have Medicare and may be shopping within their current carrier or across carriers, and those who are aging into Medicare and going through the initial enrollment period.

What’s most important for each Medicare shopper to know is that there is no one-size-fits-all plan. Every individual’s needs are different, so each person should look for information from trusted sources in order to better understand their options and the process for enrolling in Medicare.

Q. When should you sign up for Medicare?

Consumers are first eligible to sign up for Medicare three months prior to turning 65 and that initial enrollment period ends three months after the month consumers turn 65. The optimal time to shop for Medicare, however, is during the Medicare annual enrollment period (AEP), which is the time during which all Medicare-eligible shoppers can join, switch or drop a plan. It’s an important time to learn about Medicare plan options and benefits and decide which plan is best for you and your unique needs.

It is also an important time for family members, friends and other caregivers to assist in assessing Medicare plan options for those who are eligible, in part due to an aging population with more complex health needs, as well as the ever-growing number of Medicare plans on the market, especially here in Massachusetts. We encourage caregivers to visit websites of different carriers, such as Blue Cross Blue Shield of Massachusetts, so they can help their family members, friends and neighbors assess their Medicare options.

Q. What does Medicare typically cover?

An individual’s coverage will be determined by the way in which they receive Medicare – whether through plans offered by the federal government or those offered by private health plans, such as Blue Cross. Regardless of the type, Medicare is not intended to cover 100% of costs for health care services, but rather to provide a set of basic medical and inpatient needs and covers approximately 80% of outpatient care costs.

• Original Medicare is offered by the federal government and covers Medicare Parts A and B
• Medicare Advantage, which is offered by private health plans such as Blue Cross and others, covers Parts A and B, but, in addition, most also include Medicare Part D, which helps cover the cost of prescription drugs.
  • Medicare Advantage includes various supplemental benefits, such as dental, vision and hearing coverage.

Some private health plans also provide other benefits that shoppers may not be seeking but can be helpful in a time of need, such as programs that help members transition from the hospital to home. At Blue Cross, for example, we offer Medicare Advantage members access to an on-staff dietician and a broad team of mental health professionals who provide guidance, education and support to promote mental and emotional well-being, to name just a few additional benefits.

Q. Are you required to enroll in Medicare at 65?

You are not required to enroll in Medicare at 65 in instances such as when you remain a full-time employee covered by a group plan that doesn’t require Medicare enrollment. It is, however, essential to understand your options at the time of eligibility. Late enrollment penalties may apply if you choose not to enroll when initially eligible or decide to enroll at a later date. Contact your employer to find out how your employer’s coverage works with Medicare.

Q. What is new with 2024 Medicare plans?

Medicare-eligible individuals should be mindful of several significant Medicare changes for 2024, as they may impact plan decisions:

• More enrollees will be eligible for a maximum cost of $35 per month for insulin, building off a key change in insulin costs in 2023.
• There is now additional coverage of mental health services provided by marriage and family therapists and mental health counselors.
• Some out-of-pocket costs for catastrophic prescription drugs will be eliminated, and there will be a slight decrease for most Part D premiums and more savings for low- and moderate-income individuals through Medicare’s Extra Help program.

Q. What are the most important things to remember when making Medicare decisions during the Annual Enrollment Period?

Medicare can be complicated, so eligible individuals must know where to find the right information and guidance to understand the basics and how the system is structured before shopping for coverage. Visit Medicare.gov, connect with a counselor via The SHINE Program or a local senior center, and take advantage of the many helpful resources at medicare.bluecrossma.com, including commitment-free online and in-person educational seminars hosted by Blue Cross Medicare experts.

Thanks to Gloria Paradiso for contributing this piece to Westwood Minute.  Ms. Paradiso is Vice President & Head of Government Sales at Blue Cross Blue Shield of Massachusetts