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  • Karen McPhail, RN, MSN

Tis the Season for Medicare Open Enrollment!

Tis the season for holiday prep and medicare enrollment! Many people become overwhelmed by this process, the many options, and available resources to assist them! This blog entry will attempt to provide some of the basics for moving forward in positive way!!!

First what is Medicare and Medicare options?

Medicare is a federally funded program that provides options for health insurance to US citizens and legal residents generally over the age of 65. Medicare is also available for individuals with certain disabilities. Approximately 57 million people are currently enrolled in Medicare.

For the 2019 coverage period, open enrollment will be offered from October 15, 2018, to December 7, 2018.

During this annual enrollment period individuals may make changes to their coverage!

There are several options in terms of the Medicare programs:

Individuals may select the "original" Medicare (Parts A and B), which is provided through the federal government.

In addition, individuals may also purchase an additional prescription drug plan and /or Medicare Supplement or Medigap plan through one of the 10 standardized plans, or a Medicare Advantage plan (Plan C), which is provided by private insurance companies that contract through Medicare.

When an individual turns 65 and first becomes eligible for Medicare, they will automatically be enrolled in the "original" Medicare program (Part A and B). One is eligible for Medicare Part A premium free beginning at this age, if they or their spouse were employed and paid into the system for at least 10 years.

In terms of Medicare Supplement or Medigap plans:

The Medicare Supplement Plans F, G, and N are offered and provide similar, yet different options to supplement healthcare coverage!

*IMPORTANT: Plan F and Plan G cover Medicare Part B excess charges, and are the only Medicare Supplement plans that do!

Medicare Supplement Plan F

Medigap Plan F offers more coverage than other Medicare Supplement plans. This is the best option if possible for individuals accessing healthcare services and physicians frequently! Although Medigap Plan F offers the most benefits, it usually comes at a cost as it is generally the most expensive of the programs.

There is also the option to purchase a high-deductible Plan F which is less costly and offers the same benefits as the standard Plan F, but requires a specific out of pocket minimum amount to be paid prior to coverage beginning.

When choosing the high-deductible Plan F, individuals are required to pay for all out-of-pocket "original: Medicare costs until you reach a designated amount, before the policy will kick in and begin to pay. The advantages of this high deductible plan is being able to have additional high level coverage at a lower monthly premium rate than the standard Plan F. Individuals just need to be aware of the out of pocket costs and plan properly for these each year.

Medicare Supplement Plan G

Medigap Plan G offers all of the benefits of Plan F, with the exception of the Part B deductible. Under Plan G, individuals need to pay the standard annual Medicare Part B deductible out of pocket.

Medicare Supplement Plan N

Medigap Plan N provides all the same benefits as Plan F with the exception of the following areas- Medicare Part B deductible and excess charges, as individuals need to pay the cost differences out of pocket for these areas.

Plan N is also a little different from Plan F because although it pays for 100% of the Part B coinsurance in most cases, there are some exceptions to this as. For example, one will need to pay a copay for certain office visits and for emergency room visits that do not result in hospital admission.

Medicare Advantage Plans:

If individuals want additional hospital / medical coverage, feeling that Part A and B will not provide enough, but a medi gap, Medicare Supplement plan is just too expensive they can purchase an often more cost effective Medicare Advantage plan, instead of traditional "original" medicare. These plans function like a traditional HMO or a PPO, so in network providers are offered and referrals needed for services, testing, etc. Most Part C plans come with prescription drug coverage, also which is a positive. If the part C selected does not have a prescription drug plan, one can be selected. Although these plans are cost effective and do the job they can be very restrictive, tough to navigate, and limited in terms of choice and quality of providers. Many individuals who wish to age in place or are in care communities may have difficulties as one is required often times under these plans to go to specific testing centers, or physical offices for access to care while other insurance programs will accommodate physician home visits and more flexibility for testing. Some individuals like the one stop shopping, all inclusive approach and elect this as an option. Plan selection always depends upon your wishes and needs.

Choices are Important:

Since these are VERY important decisions I recommend that my clients speak with the Virginia Insurance Counseling and Assistance Program (VICAP) or a trusted, licensed, trained, and certified insurance agent to discuss all their options! These services are free of charge to individuals seeking policies so it is a no lose situation! Start the process out right by getting the guidance you need! Feel free to reach out via my contacts tab with any questions! I am here to help! Some links are below for vendors providing support and guidance for Medicare plan selection!

Trusted Resources:


Medicare Portal:

Virginia Medical Plans:


#medicareprograms #medicareopenenrollment #medicareenrollment

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