Bright Health’s answers to your Annual Enrollment Period and Medicare FAQs.

Here’s everything you need to know before the Annual Enrollment Period (AEP) ends on December 7.

Medicare Basics


What is Medicare?

Also referred to as Original Medicare because it is Medicare offered by the federal government to U.S. citizens who are 65 and older, or younger with a qualifying disability. Medicare has two distinct parts: Part A and Part B. Together, they can help cover some (about 80%) of Medicare approved hospital costs and doctor visit expenses.

There are also Medicare plans offered through private insurance companies: Part C (or Medicare Advantage plans) and Part D (prescription drug plans). To enroll in either Medicare plan you must first enroll in Original Medicare.

Who is eligible for Medicare?

You qualify for Original Medicare if:

  • You are 65 or older or younger with a qualifying disability
  • You’re a U.S. citizen (or legal permanent resident who has been in the US for at least the last five years)
  • You or your spouse (deceased or alive) paid Medicare taxes for at least ten years

When can I enroll in a Medicare plan?

Medicare’s Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, all Medicare eligible individuals, if they have Original Medicare, can change plans or enroll in a Medicare plan for the first time, if they missed the opportunity during what’s called their initial enrollment period (3 months before, the month of and 3 months after your 65th birthday month).

What if I miss the Annual Enrollment Period?

Outside of AEP, there are a few other opportunities to enroll or disenroll in a Medicare plan.

  • Initial Enrollment Period (IEP): This is a window of time that starts three months before your 65th birthday and continues for three months after your birthday month.
  • Special Enrollment Period (SEP): Available when life changes or special circumstances occur outside of AEP that result in needing to change your current health plan (plan is discontinued, retirement, move out of service area, etc).
  • Open Enrollment Period (OEP): Medicare eligible persons can make “like plan” changes from January 1 - March 31.

It’s a good idea to review your healthcare needs every year to be sure your coverage still works for you, your prescription drugs are covered, and the plan fits your budget. If you need to make changes you can do so during AEP.

Types of Medicare and Other Plans


What are the different types of Medicare plans?

Medicare “Part A” and “Part B” are often called “Original Medicare”.

  • Part A is hospital coverage, covering inpatient hospital care, inpatient stays in most nursing facilities, hospice and home health service.
  • Part B is medical coverage, covering doctor and clinical lab services, outpatient & preventative care services, home health care, screenings, surgical fees and supplies, physical and occupational therapy.
  • Part C is often called “Medicare Advantage.” Medicare Advantage is a different way of getting both Medicare Part A and Part B coverage in one convenient plan and includes extra benefits and can include prescription drug coverage-often for no additional monthly premium- that you don’t get with original Medicare. Medicare Advantage plans are offered through private companies, like Bright Health. Medicare Advantage plans are county level plans, meaning you must live in the county the plan is offered to qualify.
  • Part D is a stand-alone prescription drug plan. Part D plan costs and drugs covered vary. Review the plan’s drug list to be sure the drugs you take are covered and fit your budget.

What “parts” of Medicare do I need?

To enroll in a Medicare plan you need Part A and B. Most people are automatically enrolled in Original Medicare Parts A. For most it comes with no monthly premium. If you’re still working and have health insurance you could wait to enroll in Part B. If you want extra benefits beyond what Original Medicare offers and/or you need prescription drug coverage you should review what Medicare Advantage (Part C) plans are available in your area. Many include prescription coverage. When you become eligible for Medicare you need to be sure you have a health plan with what’s called creditable prescription drug coverage to avoid penalties.

What is Medicare Advantage and how is it different from Original Medicare?

Some key differences between Original Medicare and Medicare Advantage are:

  • Original Medicare does not include an out-of-pocket maximum limit per year or provide coverage for prescription drugs, nor does it include extra benefits like dental, vision or hearing care that you could get with a Medicare Advantage plan.
  • A Medicare Advantage (Part C) plan often include prescription drug coverage, and has an out-of-pocket maximum that gives members an easier way to budget annual healthcare costs, and includes extra benefits often for no additional monthly premium and may offer comprehensive dental and vision coverage.

How do I apply for Medicare Part B? Is there a late penalty?

Some people are automatically enrolled in Original Medicare (Parts A & B).and you can decide to wait to accept Part B benefits. Visit medicare.gov  to find out more or call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week.

Usually, if you don't sign up for Part B when you're first eligible, you'll have to pay a late enrollment penalty. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up.

What’s a Medicare Supplement Plan and between a supplement plan and Medicare Advantage?

Medicare Supplement Insurance, sometimes called “Medigap”, helps pay the 20% of Medicare covered costs that Original Medicare doesn’t pay. You must have Medicare Part A and Part B to sign up for a Medigap policy.

A Medigap policy is not the same as a Medicare Advantage plan-- it is not an all in one plan. It’s a separate plan to fill in the gaps of Original Medicare and does not include prescription drug coverage. If you need drug coverage with a Medigap plan you would need to also enroll in a Part D prescription drug plan. You cannot have both a Medicare Supplement Plan and a Medicare Advantage plan.

What is an HSA Plan? Can I use it with my Medicare plan?

An HSA or “Health Savings Account” is a pre-tax savings accountthat you can use to pay for medical costs.. Once you enroll in Medicare Part A and/or B, you can no longer contribute to your HSA. However, you may continue to withdraw money from your HSA after you enroll in Medicare to help pay for medical expenses. If you use the account for qualified medical expenses, funds distributed are tax-free.

Bright Health

November 18, 2018