Getting started, getting help and navigating open enrollment

For many Americans the most difficult and important decision as they reach retirement is determining which Medicare health plan, Medigap coverage or Medicare Advantage plans best fits their needs.

And this month, Medicare’s open enrollment period — Oct. 15 to Dec. 7 — offers an opportunity for seniors to join, switch or drop plans with changes taking effect Jan. 1, 2023.

As plans and benefits change from year to year, it makes sense to evaluate coverage and options annually. Thankfully, there’s help navigating the process.

Enrollment and elgibility

First, a summary of Medicare plans and options:

An introduction to government health insurance plans is available at www.medicare.gov, the federal website managed and paid for by the U.S. Centers for Medicare & Medicaid Services.

Visitors to this site will find explanations of the different parts of Medicare and a downloadable booklet, “Medicare and You,” which outlines plans and programs.

Some key facts: this federal health insurance program becomes available to legal U.S. residents at age 65; persons with a disability and certain medical conditions may qualify at a younger age.

Generally, persons already receiving Social Security benefits prior to age 65 are automatically enrolled; persons who are not getting benefits are encouraged to sign up three months prior to their 65th birthday.

Persons who delay signing up may face penalties for late enrollment.

The program helps with the cost of care, but it doesn’t cover all medical expenses including dental and eye care or the cost of most longterm care.

Medicare components

• Part A: Hospital insurance which helps cover in-patient care in hospitals, skilled nursing facility care, hospice care and home health care.

• Part B: Medical insurance which helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment (wheelchairs, walkers, hospital beds and other equipment) and many preventive services (such as screenings, shots or vaccines and yearly “wellness” visits).

• Part C / Medicare Advantage: “All in one” alternatives to so-called Original Medicare, these “bundled” plans include Part A, Part B, and usually Part D.

Plans may have lower out-of-pocket costs than original Medicare. In most cases, participants need to use doctors who are in the plan’s network.

Most plans offer extra benefits that original Medicare doesn’t cover — vision, hearing, dental and more.

• Part D: Drug coverage which helps pay for the cost of prescription drugs (including many recommended shots or vaccines). Part D plans are run by private insurance companies that follow rules set by Medicare.

While the federal government has programs to help people with difficulty paying Medicare premiums, there’s also a federal and state operated program, Medicaid (Medi-Cal in California), which assists people who have limited resources and offers benefits, such as nursing home care, not offered by Medicare.

Each state has different rules about Medicaid eligibility. Information about California requirements can be found at benefits.gov/benefit/1620, with enrollment information at coveredca.com.

Advice and assistance

A good first step: download and/or get a printed copy of the government publication: “Medicare and You 2023” at medicare.gov, order a printed copy online or call 800-663-4277.

The Medicare website is a good first stop to learn more about programs and options.

Help also can be found through a trusted, independent insurance brokers who specializes in healthcare coverage.

Insurance brokers may be independent and offer policy options from a variety of companies or may only sell policies from one company and be paid on commissions from that company.

In California, brokers or agents must be licensed. To check a license by individual, company name or license number go to insurance.ca.gov/0200-in

dustry. Assistance is also available through nonprofits including the California Health Advocates, cahealthadvocates.org, which supports the state’s Health Insurance Counseling & Advocacy Program.

HICAP counselors offer assistance in selecting Medicare plans, answer questions and assist enrollees with appeals involving denial of coverage. HICAP does not sell, endorse, promote or recommend commercial insurance products or services.

Where to schedule a telephone counseling session with HICAP:

• Los Angeles County (as part of the Center for Health Care Rights) at www.healthcarerights.org or by calling 800-824-0780 or 213-383-4519

• Orange County (as part of Council on Aging — Southern California) at www.coasc.org, email [email protected] or call 714-560-0424

• Riverside and San Bernardino counties (as part of Council on Aging — Southern California), at 9121 Haven Ave., Suite 220, Rancho Cucamonga; 909-256-8369

Hours are Monday-Friday, 9 a.m. to 4 p.m.

State HICAP information hotline: 800-434-0222