Medicare Open Enrollment: How to Find the Right Care for You

Medicare’s annual open enrollment period runs from Oct. 15 through Dec. 7. Every year at this time, people who are already enrolled in Medicare review their coverage, explore available options and make changes for the coming year.

Whether you’re considering a change or simply want to better understand your coverage, here are some important questions to ask, information on how to get help if you need it and advice on how to make the most of your healthcare coverage.

You Don’t Have to Navigate Medicare Alone

Whether you’re new to Medicare or you’ve had the same coverage for years, an annual conversation with a licensed Medicare insurance adviser—at no cost to you—can help you identify changes to your benefits, prescription coverage or provider network. Your adviser can also estimate your potential out-of-pocket costs.

Cedars-Sinai works with independent, licensed Medicare insurance agents who can help you understand your options and find the coverage that meets your individual healthcare needs, preferences and budget.

These advisers aren’t Cedars-Sinai employees. They work with multiple insurance companies and can help you compare different plans and healthcare provider networks. Their goal is to help you make an informed decision, whether that means selecting a plan that includes Cedars-Sinai or choosing another option that better meets your needs.

Visit cedars-sinai.org/AEP or call 310-846-4177 to speak with a licensed Medicare insurance adviser at no cost to you.

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Questions to Ask Before Choosing Your Medicare Coverage

Your healthcare needs can change from year to year. So can Medicare plans. As you’re deciding whether to keep your current coverage or make a change, consider these important questions.

Have Your Healthcare Needs Changed?

Think about the care you’ve needed over the past year and what you might need in the year ahead. Ask yourself:

• Are you seeing your primary care physician more frequently?
• Have your prescription medications changed?
• Do you need access to specialists or additional services?
• Are dental, vision or hearing benefits important to you?

Your answers can help determine which type of coverage makes the most sense for you.

What’s the Difference Between Original Medicare and Medicare Advantage?

Medicare offers two primary ways to receive your coverage: original Medicare and Medicare Advantage. Which one is right for you depends on your individual healthcare needs, provider preferences and budget.

Original Medicare includes Part A, which helps cover hospital care, and Part B, which covers doctor visits,outpatient services and other medically necessary care. It generally provides coverage when you receive care from any doctor or hospital in the U.S. that accepts Medicare.

Original Medicare does not include prescription drug coverage, but you can choose to purchase a separate Part D prescription drug plan to help cover medication costs. In addition, you may want to purchase Medicare supplement insurance, commonly called Medigap, to help cover out-of-pocket expenses not covered by original Medicare.

Medicare Advantage (also known as Part C) is an alternative offered by private insurance companies approved by Medicare. These plans include your Part A and Part B benefits and often include prescription drug coverage (Part D). They also may offer additional benefits, such as dental, vision or hearing services.

Many Medicare Advantage plans use provider networks and only provide coverage when you receive care from a doctor or hospital that is in your plan’s provider network. So, it’s important to confirm that your preferred doctors, specialists and hospitals participate in the specific plan you’re considering.

Can You Keep Your Doctors and Access the Care You Want?

If you have a primary care doctor or specialist you trust, make sure that provider participates in the Medicare plan you’re considering. You also should review the hospitals and specialty services available to you to make sure your preferred options are covered under your plan.

For example, some Medicare Advantage plans that provide coverage in Los Angeles County offer access to the Cedars-Sinai Physician Network, connecting patients with more than 1,500 physicians and specialists across Los Angeles and the San Fernando Valley.

What Will Your Healthcare Really Cost?

The plan with the lowest monthly premium isn’t necessarily the one that will cost you the least over the course of the year. When comparing coverage, consider your total potential healthcare expenses, including:

• Monthly premiums
• Deductibles
• Copayments
• Coinsurance
• Prescription medication costs

If you take prescription drugs, review each plan’s formulary, or list of covered medications. Check whether your prescriptions are included, what they will cost and whether your preferred pharmacy participates.

If you’re considering original Medicare, you also may want to explore purchasing prescription drug (Part D) coverage and/or Medigap coverage, which can help pay certain expenses that original Medicare doesn’t cover.

If you’re considering Medicare Advantage, compare each plan’s benefits, provider network and annual out-of-pocket maximum for covered Part A and Part B services.

Is Your Current Plan Still the Best Choice?

Annual enrollment is your opportunity to make changes for the coming year. Don’t assume that the plan you selected several years ago is still your best option today.

Insurance companies can change their premiums, deductibles, copayments, prescription drug coverage and provider networks from year to year. Your healthcare needs may have changed, too. If you’re already enrolled in a Medicare plan, you will receive an Annual Notice of Change. Review this document carefully, as it will outline all changes to your coverage, benefits and costs for the coming year. You can also review Medicare Advantage plans’ quality and performance ratings through Medicare’s five-star rating system. Visit medicare.gov and use the Medicare Plan Finder to compare plans available in your area.

Get Answers. Explore Your Options. Make an Informed Decision.

Whether you’re approaching Medicare eligibility, considering a change during open enrollment or simply wanting a refresher, Cedars-Sinai offers resources to help you navigate your options.

Speak With a Licensed Medicare Adviser

Get personalized guidance at no cost to you. Independent, licensed Medicare insurance agents can answer your questions, compare available options and help you find coverage that fits your individual needs.

Visit cedars-sinai.org/AEP or call 310-846-4177.

Register for a Free Medicare 101 Webinar

Whether you’re new to Medicare or have been enrolled for years, a Cedars-Sinai Medicare 101 webinar is a great opportunity to get informed before making your next healthcare decision.

Led by a licensed Medicare insurance professional, these sessions explain the fundamentals of Medicare, explore the different coverage options and provide an opportunity to ask questions.

Medicare coverage, plan availability and provider participation vary by plan and service area. Confirm coverage and network participation before enrolling.