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If you’re on Medicare
or about to be, you’ve probably heard the term Annual Enrollment
Period (AEP). It might sound complicated, but don’t worry. It’s actually
pretty simple once you break it down and know what you need to focus on. Let’s
walk through what the Annual Enrollment Period is, why it matters, and how it
gives you the chance to make sure your healthcare coverage is right for you and
your healthcare needs.
The Medicare Annual
Enrollment Period happens every year from October 15 to December 7. During this time, anyone with Medicare
can make changes to their coverage. These changes take effect on January 1
of the following year.
Think of it like a
yearly “check-up” for your Medicare plan. Your health needs, medications, and
budget change over time. AEP gives you the chance to adjust your coverage so it
fits your life.
During the Annual
Enrollment Period, you can:
Basically, if you’re not
happy with your current coverage or just want to see if there’s something
better, this is the time to make changes.
Before we talk more about AEP, let’s go over the different parts of Medicare. Understanding these parts makes it easier to know your options.
●
Switch from a
Medicare Advantage plan back to Original Medicare
●
Change from
one Medicare Advantage plan to another
●
Join, drop, or
switch Medicare Part D (prescription drug coverage)
Medicare Part A – Hospital Insurance
●
Helps cover
inpatient hospital stays, skilled nursing facilities, hospice care, and some
home health care.
●
Most people
don’t pay a monthly premium for Part A because they or their spouse paid
Medicare taxes while working.
●
Helps cover
doctor visits, outpatient care, preventive services, and medical supplies.
●
You pay a
monthly premium for Part B.
●
These are
private health plans (offered by insurance companies) that combine Parts A and
B, and often include Part D (prescription drugs).
●
Many plans
also offer extras like dental, vision, hearing, and fitness benefits, like
SilverSneakers.
●
You may need
to use doctors and hospitals in the plan’s network.
Medicare Part D – Prescription Drug Coverage
●
Helps pay for
prescription medications.
●
Plans are
offered by private insurance companies, and costs can vary.
Your health and needs can
change from year to year. Maybe you’re taking new prescriptions. Maybe your
doctor is no longer in your plan’s network. Or maybe you’ve heard about a plan
with extra benefits that would save you money.
The Annual Enrollment Period is your chance to:
●
Make sure your
prescriptions are covered at a good price.
●
Check that
your favorite doctors are still in-network.
●
Compare costs
like premiums, co-pays, and deductibles.
●
See if you can
get extra benefits with a Medicare Advantage plan.
●
Review your Annual Notice of Change. Each fall, your plan will send a letter
explaining what’s changing for the next year. Don’t skip it!
●
Make a list of your current prescriptions and
doctors. This helps you
compare plans to see if they cover what you need.
●
Think about your budget. Sometimes a plan with a low monthly premium ends up
costing more in co-pays. Look at the big picture.
●
Don’t wait until the last minute. December 7 comes quickly, so give yourself
time to review your options.
The search for the right primary care doctor can feel overwhelming. Many patients express frustration with long wait times, short visits, and difficulty accessing their physician when they need them most. In todays fast-paced healthcare environment, finding a doctor who prioritizes patient care is more important than ever. One emerging alternative is Direct Primary Care (DPC), a model that shifts the focus back to the patient by eliminating insurance hassles. Instead of dealing with copays and billing, patients pay a flat monthly fee for direct access to their doctor, longer appointment times, and a more personalized healthcare experience. Availability and Access How long will it take to get your first appointment? Some traditional practices have months-long waits. In contrast, DPC providers typically offer initial visits within a week, ensuring you receive care when you need it. Office Experience Time spent in the waiting room can be a major frustration. In conventional practices, patients may wait an hour or more before seeing the doctor. DPC practices prioritize efficiency, often reducing wait times to just minutes. Time With Your Doctor Short, rushed appointments can leave patients feeling unheard. In many traditional offices, physicians are booked in 15- to 20-minute intervals, limiting discussion time. DPC physicians often schedule longer visits sometimes up to an hourallowing for in-depth conversations, thorough exams, and more thoughtful treatment plans. Communication and Follow-Up Reaching your doctor can be a challenge. Many patients endure long hold times or leave messages that go unanswered. In the DPC model, direct communication is key. Patients often have access via phone, email, or text for prompt, personalized care. Urgent Needs Medical concerns dont always arise during business hours. Traditional practices may not offer same-day visits, pushing patients toward urgent care or ERs. DPC providers aim to accommodate same- or next-day appointments, reducing unnecessary trips and ensuring continuity of care. Choosing a primary care doctor is personal. Look for a physician who is experienced, accessible, compassionate, and committed to your well-being. Asking the right questionsand exploring models like DPCcan lead to a more satisfying healthcare experience. Editors Note: This article was written by Dr. Rebecca L. Byard, Family Medicine Doctor with Direct Care Physicians of Pittsburgh. She can be reached at 412-892-9170 or visit their website at wwwdirectcarepgh.com. See ad on pages 2-3.
Medicare and health plans can be complex, but understanding the basics can help you make informed decisions about coverage whether you are already on Medicare or just about to start. First, Medicare includes Part A (hospital) and Part B (medical), is provided by the government. Part A covers hospital stays, skilled nursing facility care, hospice, and some home health care. Part B covers outpatient care, doctor visits, preventive services, and medical supplies. Medicare doesnt cover everything, which means your cost may be higher on certain services.To provide additional coverage, many individuals opt to enroll in a Medicare Advantage plan (Part C) or Medicare prescription drug plan (Part D) to supplement their benefits. Medicare Advantage plans are offered by private insurers, these plans bundle Parts A and B and often include prescription drug coverage (Part D) and additional benefits, such as dental, vision, and hearing.Medicare Advantage plans vary in their networks of doctors, hospitals, and prescription drug coverage. So, it is essential to carefully compare them to ensure they cover the doctors and prescriptions you need.Its important to consider your health status, the prescription medications you take, any chronic conditions you may have, even the gyms you go to. This will help you determine the plan and level of coverage you require. Its important to consider your budget when selecting a Medicare plan. Take into account monthly premiums, deductibles, and copayments each plan may have.For those just about to start Medicare you have a limited window of opportunity to choose a plan. Deadlines can apply when you turn 65 or when you choose to retire. For those already on Medicare, health plans can change from year to year, including coverage, costs, and provider networks. So, taking time to review your options is important. The Annual Enrollment Period (October 15 to December 7) is your opportunity to reassess your Medicare coverage to ensure it still meets your needs. Finally, many find navigating this complex world of Medicare overwhelming. If this is you, then you are not alone. The solution is having a knowledgeable, licensed insurance agent by your side to ensure youre making the best choice for your healthcare needs. Editors Note: This article was submitted by Carleen Lachman. Carleen is an Independent Insurance Broker and owner of Prioritize Health. She may be reached at 724-571-4688 or by email at carleen@prioritizehealthpa.com. See ad on page 87.
Having just completed another Annual Enrollment Period, reviewing coverage options and costs, I thought it appropriate to learn some interesting facts about Medicare. Since President Lyndon B. Johnson signed Medicare into law on July 30, 1965, millions of Americans have relied on it for medical care.Part A and Part B, called original Medicare, were included in the 1965 law. In 1997, Congress created Part C, now Medicare Advantage, the private insurance alternative. In 2003, lawmakers added Part D, covering prescriptions.Today, more than 67.4 million Americans are enrolled over 60 million are 65+ and 7 million are younger people with disabilities. President and First Lady Truman were the first Medicare beneficiaries.The Centers for Medicare & Medicaid Services has 10 regional offices, serving approximately 125 million people with Medicaid and Medicare coverage.Medicare helped desegregate hospitals after the Civil Rights Act. To receive federal funding, hospitals had to comply and desegregate.51 million people are enrolled in Medicare Part B, which helps pay for physician, hospital, outpatient, some home health, and preventive services.Last year, over 16 million people chose a private Medicare Advantage plan, like an HMO or PPO, as an alternative to original Medicare.Currently, 41 million Medicare beneficiaries have prescription drug coverage through a Medicare health plan or stand-alone prescription drug plan.Some items and services Medicare doesnt cover include: Eye exams (for prescription eyeglasses) Long-term care Cosmetic surgery Massage therapy Hearing aids and exams for fitting themAs we approach the 60th anniversary of the Medicare and Medicaid Act, keep in mind that if you need assistance with your Medicare decisions, a licensed advisor can help. Theyll learn about your health goals and budget, present options, and help you enroll. Crystal Manning has over 35 years of experience assisting clients. Editors Note: This article was submitted by Crystal Manning. She can be reached at 412-716-4942 or crystalmanning33@gmail.com. You may also contact her daughter, Dvyona Sedlacko-Stephens, at 412-657-3889 or djsedlacko@gmail.com. See ad on page 85.
VIPcarePreventative CareUtilizing a value-based Medicare Advantage model produces lower rates of hospital stays, emergency department visits, and 30-day readmissions for beneficiaries as compared to Traditional Medicare health models.5-Star ProviderThe Centers for Medicare & Medicaid Services use a five-star quality rating system to measure Medicare beneficiaries experience with their health plans and the health care system.Patients 65+ require different attention and care than other age groups. VIPcare provides senior-focused primary care that caters specifically to the needs of older adults.What is Senior-Focused Care?Senior-focused care is primary care that delivers a wide range of value-based healthcare services with a dedicated focus on patients 65+. It takes the unique needs of the senior population into consideration when caring for patients.How Is Senior-Focused Primary Care Different than Traditional Primary Care?At VIPcare, youll notice many differences between how we care for patients and how others do. Because VIPcare specializes in caring for adults 65+, our providers are trained and specialized in the specific clinical needs of seniors. We focus on prevention and management, helping to achieve Better Health. Also, using a value-based model allows our providers to spendmore time with patients. Instead of waiting for an appointment, our providers can see you right away, sometimes even the same day if needed.What are the Benefits of Senior-Focused Care?Many older adults live with multiple chronic conditions, such as hypertension (high blood pressure), diabetes, heart disease, and arthritis. By having a primary care provider that is skilled and trained to treat the senior population and their specific needs, such as chronic conditions, patients receive better and more personalized care. In addition, senior-focused care integrates a team approach and coordinates with specialty care when necessary.What Insurance is Needed for Senior-Focused Care?Senior-focused primary care is best delivered as part of a value-based model and works best when paired with Medicare Advantage plans. However, some VIPcare clinics do accept traditional Medicare.Learn More About Senior-Focused Care at VIPcareVIPcare provides senior-focused primary care to the aging population. We believe in quality over quantity and always strive to deliver 5-star care. Learn more about what makes VIPcare different by scheduling an appointment or calling 251-257-2886.
VIPcarePreventative CareUtilizing a value-based Medicare Advantage model produces lower rates of hospital stays, emergency department visits, and 30-day readmissions for beneficiaries as compared to Traditional Medicare health models.5-Star ProviderThe Centers for Medicare & Medicaid Services use a five-star quality rating system to measure Medicare beneficiaries experience with their health plans and the health care system.Patients 65+ require different attention and care than other age groups. VIPcare provides senior-focused primary care that caters specifically to the needs of older adults.What is Senior-Focused Care?Senior-focused care is primary care that delivers a wide range of value-based healthcare services with a dedicated focus on patients 65+. It takes the unique needs of the senior population into consideration when caring for patients.How Is Senior-Focused Primary Care Different than Traditional Primary Care?At VIPcare, youll notice many differences between how we care for patients and how others do. Because VIPcare specializes in caring for adults 65+, our providers are trained and specialized in the specific clinical needs of seniors. We focus on prevention and management, helping to achieve Better Health. Also, using a value-based model allows our providers to spendmore time with patients. Instead of waiting for an appointment, our providers can see you right away, sometimes even the same day if needed.What are the Benefits of Senior-Focused Care?Many older adults live with multiple chronic conditions, such as hypertension (high blood pressure), diabetes, heart disease, and arthritis. By having a primary care provider that is skilled and trained to treat the senior population and their specific needs, such as chronic conditions, patients receive better and more personalized care. In addition, senior-focused care integrates a team approach and coordinates with specialty care when necessary.What Insurance is Needed for Senior-Focused Care?Senior-focused primary care is best delivered as part of a value-based model and works best when paired with Medicare Advantage plans. However, some VIPcare clinics do accept traditional Medicare.Learn More About Senior-Focused Care at VIPcareVIPcare provides senior-focused primary care to the aging population. We believe in quality over quantity and always strive to deliver 5-star care. Learn more about what makes VIPcare different by scheduling an appointment or calling 251-257-2886.
VIPcareWe are a group of passionate healthcare professionals who believe theres a better way to practice medicine. We see a future where preventative medicine is valued over the traditional approach, what we refer to as sick care. We thrive on seeing our patients healthy, not sick.Preventative CareUtilizing a value-based Medicare Advantage model produces lower rates of hospital stays, emergency department visits, and 30-day readmissions for beneficiaries as compared to Traditional Medicare health models.5-Star ProviderThe Centers for Medicare & Medicaid Services use a five-star quality rating system to measure Medicare beneficiaries experience with their health plans and the health care system.Patients 65+ require different attention and care than other age groups. VIPcare provides senior-focused primary care that caters specifically to the needs of older adults.What is Senior-Focused Care?Senior-focused care is primary care that delivers a wide range of value-based healthcare services with a dedicated focus on patients 65+. It takes the unique needs of the senior population into consideration when caring for patients.How Is Senior-Focused Primary Care Different than Traditional Primary Care?At VIPcare, youll notice many differences between how we care for patients and how others do. Because VIPcare specializes in caring for adults 65+, our providers are trained and specialized in the specific clinical needs of seniors. We focus on prevention and management, helping to achieve Better Health. Also, using a value-based model allows our providers to spendmore time with patients. Instead of waiting for an appointment, our providers can see you right away, sometimes even the same day if needed.What are the Benefits of Senior-Focused Care?Many older adults live with multiple chronic conditions, such as hypertension (high blood pressure), diabetes, heart disease, and arthritis. By having a primary care provider that is skilled and trained to treat the senior population and their specific needs, such as chronic conditions, patients receive better and more personalized care. In addition, senior-focused care integrates a team approach and coordinates with specialty care when necessary.What Insurance is Needed for Senior-Focused Care?Senior-focused primary care is best delivered as part of a value-based model and works best when paired with Medicare Advantage plans. However, some VIPcare clinics do accept traditional Medicare.Learn More About Senior-Focused Care at VIPcareVIPcare provides senior-focused primary care to the aging population. We believe in quality over quantity and always strive to deliver 5-star care. Learn more about what makes VIPcare different by scheduling an appointment or calling 251-257-2886.