12 things you may not know about Medicare Advantage

Your annual opportunity to enroll in a Medicare Advantage plan or switch plans is coming up fast. The window opened on Oct. 15 and is only open for about seven weeks, until Dec. 7.

If this is your first time as a Medicare enrollee, you may find it overwhelming. Kudos to the Centers for the U.S. Centers for Medicare and Medicaid Services (CMS), which expends a great deal of effort to communicate on the Medicare website and through the mail. Their advice is usually clear and easy to understand. But how do you fit in to the system? And how do you avoid the pitfalls?

Here are some tips that may help:

1.) Medicare enrollment periods are different. The period to sign up for a Part C, or Medicare Advantage plan offered by private companies, is Oct. 15 to Dec. 7. But if you're signing up for Medicare for the first time, the enrollment period is Jan. 1 to March 31 each year, with coverage starting July 1, unless you qualify for special enrollment. Special enrollment kicks in when, for example, you retire and your employer coverage ends.

2.) You don't pay a premium for Medicare Part A, and premiums for Part B can vary. In 2021, most people pay the Part B premium of $148.50 a month, which is deducted from your Social Security payments. But if your last tax return reported higher incomes (more than $88,000 for individual, $176,000 for joint), the premium rises on a sliding scale. CMS will announce 2022 premiums later in the year.

3.) You sign up for Medicare through the Social Security Administration, not CMS. The applications are online, and if you're not already receiving Social Security payments you can sign up for Medicare only.

4.) Sign up on time or pay a penalty for the life of your Part B coverage. Your initial enrollment period begins three months before your 65th birthday, includes the month you turn 65, and ends three months after that birthday. You can also sign up during the general enrollment period, Jan. 1 to March 31.

5.) Medicare Advantage plans vary by where you live. If you're planning to relocate after retirement, don't assume your coverage will stay the same.

6.) Some Medicare Advantage plans advertise “no premium,” but, of course, you're still paying your Part B premium, which is collected by the insurance company. So, really, they should say there's no additional premium.

7.) Medicare Advantage plans have a range of costs and quality, so Medicare assigns them star ratings based on preventive care, management of chronic conditions, customer service and complaints. You can compare plans in your area by visiting Medicare's plan-finder tool. Ratings are updated each fall and may change.

8.) If a five-star plan is available in your area, you can switch to it during the five-star special enrollment period Dec. 8 through Nov. 30.

9.) Love your doctor? Some practices don't take new Medicare patients at all, so make sure yours does. Find out which Medicare Advantage networks they participate in before choosing a plan.

10.) The same plan isn't necessarily right for both spouses. For example, if one spouse has Type 2 diabetes, you will want to look for a plan that caps the co-pay for insulin.

11.) To get the best estimates of your out-of-pocket costs, sign in to the Medicare website and list your medications. Also consider whether there are copays for visits to your primary care doctor and how much you will pay for specialists, lab work, etc. While cost isn't the only factor in choosing a Medicare plan, it's certainly important to most of us.

12.) You will be inundated with online ads, mailings, maybe even phone calls. When you're shopping for a Medicare Advantage plan online, consider the source. Sites ending in .com may be out to sell you something. Look for sources ending in .org or .gov.

I can't emphasize this enough: Don't just roll over your plan from year to year without examining the details of how it may be changing. Your plan provider has to send you an annual Notice of Change.

Finally, if you need guidance, ask for it. Every state offers free Medicare advice through its state health insurance assistance program. In Illinois, call (800) 548-9034. Licensed Medicare insurance brokers, who have to complete annual training, pass a test and follow Medicare's marketing rules, are available. They are paid commissions by the companies, so their assistance is free to you. A patient advocate, who has a background in health care, can assess your health needs and advise what coverage you may need.

Now that you know a bit more about Medicare Advantage, don't wait until the last minute to make your selections!

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She is offering a free, 30-minute phone consultation by calling (312) 788-2640 to make an appointment.