The Medicare Open Enrollment period began on October 15th and runs through December 7, 2024, for people aging into Medicare at 65, or those making changes to their healthcare plan for 2025. This is the time to make an appointment with a trained SHINE counselor to assess your healthcare needs for the coming year. MidPoint Wednesday was privileged to be joined by SHINE Florida’s Amy Hagel and their award-winning Medicare navigator, Fran Oberne, to educate us about the changes affecting Medicare for 2025. The SHINE (Serving Health Insurance Needs of Elders) Program provides health insurance information and free, unbiased, and confidential counseling assistance to Medicare beneficiaries, their families, and caregivers. SHINE is a free program offered by the Florida Department of Elder Affairs and your local Area Agency on Aging. Specially trained volunteers can assist you with your Medicare, Medicaid, and health insurance questions by providing one-on-one counseling and information. SHINE services are free, unbiased, and confidential, but on MidPoint, listeners were able to get answers to their Medicare questions from our guests on air.
Don’t Set It and Forget It!
The most important advice we received from Medicare navigator Fran Oberne was to review your Medicare plan with a SHINE counselor every year to ensure that you always have the best plan to meet your needs for the coming year. Every year, many healthcare plans make significant changes in their drug formularies, provider networks, and the benefits they offer. It is important to match with a plan that accommodates your healthcare priorities so that you can be prepared for the coming year. Changes to your health insurance can usually be made without penalty during the open enrollment period.
Original Medicare vs Medicare Advantage Plans?
Fran emphasized that everyone eligible should sign up for Medicare Part A (in hospital care) at age 65 because it is free. There’s no reason not to sign-up and delaying your enrollment in Part A may cause you to incur penalties should you later wish to enroll. The premiums for Part A are paid by the government, not you. Then, you must decide whether or not to enroll in Original Medicare which allows you to see any physician or provider who accepts Medicare, and to utilize any hospital or medical service without being restricted to a particular network. Original Medicare is an 80/20 cost-sharing program, so along with that, you would generally need a Medigap or Medicare supplement policy to cover the 20% of expenses that Medicare does not, and a prescription drug plan to pay for your medications. Generally, Original Medicare plus a Medigap policy plus a drug plan (Part D) is much more expensive than a Medicare Advantage plan because you pay premiums for your Medigap policy and your drug plan out of your pocket, but it generally provides the widest opportunities for care. A Medicare Advantage plan is a private insurance product that bundles the three components of Original Medicare together (Part A, Medigap, and Part D drug plan,) and often offers additional perks like vision and dental benefits that Original Medicare does not include. Some Medicare Advantage Plans also have $0 premiums. However, many Medicare Advantage plans require you to see only providers “in-network” for the most economical price, specialists at a higher price, and their drug formularies may be more restrictive or expensive. Additionally, you may find it more difficult to obtain authorization for coverage for some of your medical expenses. Some hospital systems are now terminating contracts with some Medicare Advantage plans due to too many denial of coverage incidents, and some Medicare Advantage plans in some areas are dropping enrollees to reduce costs. Deciding on what Medicare program best meets your healthcare needs is a complicated question, and that’s why the yearly assistance of a free, trained SHINE counselor is so valuable.
You can schedule your confidential counseling session with a SHINE counselor by calling SHINE at 1-800-96-ELDERS or by visiting their website at floridashine.org SHINE offers Open Enrollment Events in Hillsborough County at the Senior Connection Center 8928 Brittany Way, Tampa, FL 33619 Hours: 9:00 a.m. – 4:00 p.m. By appointment only on:
Friday, October 25
Saturday, November 16
Wednesday, December 4
This complete MidPoint show can be accessed here, on the WMNF app, or as a WMNF MidPoint podcast wherever you get your podcasts.
