Interview: Breaking Down Medicare and Open Enrollment

I interviewed Angelia Owens, a licensed insurance agent in the state of Missouri. Why did I choose Angelia to interview? Because not only does she understand the ins and outs of insurance options, but she is also a lupus warrior. So she knows what lupus patients need when they end up on disability and on Medicare, from her personal experience. So let’s get into it.

The importance of insurance with lupus

Angelia: Please note that the following is the “norm”, not an absolute in every case. I have been in the health and Medicare industry since 1999. Being a “lupie” myself, I understand the importance of insurance. I also have seen the many changes over the years that have led to higher prices and less freedom of choice.

It’s important to know all your options and to find someone in your local area that you can trust and lead you down the right path.

Medicare and open enrollment

What is open enrollment?

Medicare “Annual Enrollment Period” is between October 15th and December 7th of each year. This is a time that you can change your advantage plan to a different advantage plan, change from a supplement to an advantage plan, or change your prescription drug plan to a different prescription drug plan. IT IS NOT a time that you can change from one supplement to another supplement.

Do I really need to review my policy every year when nothing changes?

Although it is recommended that you review your plans during this period, you do not have to. If you do nothing, you will remain on the same plan that you are currently on. It is important to note that although you will remain on the same plan, the benefits of the plan could change in the coming year. Also, the drug formularies could be different. This is why it is recommended that you review the plan with your agent.

Why are there so many parts to Medicare? My other insurance covered everything?

Part A covers approved in-patient hospitals stays, care in a skilled nursing facility, and hospice care. Part B covers certain medical expenses, such as doctors, outpatient care, medical supplies, and preventative services. Part D is prescription drug coverage. Then you can get supplements to pick up what part B doesn’t cover.

Do I really need Part A, Part B, a supplement, and a Part D plan?

If you are eligible for Medicare and do not have “creditable coverage”, such as group employer coverage, tri-care, etc., then it is advisable to get Part A, B, and D as soon as you are eligible.  If you do not, then you will be charged a penalty for part b and d when you do get it. If you are on a group employer plan, it is still advisable to get Part A. Part A is usually free due to your previously paid Medicare taxes, and will work well with your group policy.

Almost losing my disability

Amber: I will say that I almost lost my disability without even knowing because I didn’t understand the whole process. I had great insurance at a great price with the Affordable Care Act (ACA). So I asked my agent at the time if I could just keep my ACA insurance and pass on Medicare. They were not sure so they sent me to the social security office (after waiting in line FOREVER).

I was given a form to sign saying I was forgoing my Medicare coverage. After doing so, I was speaking to someone else who knew a LOT about disability and Medicare. They told me that this can’t be done, and by doing so I would forfeit my disability all together.  I called the social security office and was told the same. If you forfeit A & B coverage you will also forfeit your disability. So I had to go and sign more papers.

I’m sharing this to say, PLEASE RESEARCH EVERYTHING before you sign any paperwork regarding your Medicare or disability.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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