Open enrollment for Medicare has begun. Here’s what you need to know when shopping for health plans

Data shows that nearly 5 million people in Delaware, New Jersey and Pennsylvania are eligible for Medicare. Medicare is a government health insurance program for adults age 65 and older and some younger people with disabilities.

Once a year, the program’s open enrollment period gives participants the opportunity to shop around and make changes to their coverage before committing to insurance plans for the coming year.

This year’s open enrollment period runs from October 15th to December 7th. Plans selected during this period will apply to coverage in 2025.

Because there are many different medical and prescription plans to choose from, cities, counties, states, and federal agencies offer assistance programs to help people through this process.

Glenda Radical leads approximately 15 Medicare advisors in Delaware County’s PA MEDI program, who advise residents on which plans are best for their health needs and financial circumstances.

“It’s so important that you just check, make sure you have a plan that works for you and don’t wait until open enrollment season ends,” Radical said. “Because once the season ends, some people may not be able to make a change until next October. So you want to make sure you do it now.”

Review of new plans

Most enrollees can choose between original or traditional Medicare insurance plans, Medicare Advantage plans, Part D prescription insurance, and supplemental insurance plans called Medigap plans.

Returning customers are likely already enrolled in some of these plans for the current year. This coverage may cover all current health needs, but Radical said that doesn’t necessarily mean it’s the best plan for next year.

This is because premium costs and deductibles can change from year to year. And this also applies to a person’s financial situation. That’s why Radical recommends everyone review their plans during open enrollment, even if they’re happy with their current coverage.

“A lot of times people say, ‘If it ain’t broke, I’m not going to fix it,'” she said. “The thing about health insurance is that maybe everything is great, but if you don’t check what the costs are from year to year, you could be stuck with a plan that could be very expensive well into the next year. ”

Plans may omit or add certain medications and prescriptions they cover. Individual physicians, specialists and healthcare organizations may also choose to leave certain Medicare plans, meaning their care and services may no longer be considered in-network for coverage.

Radical and its team of advisors advise residents on this by conducting plan comparisons for people considering their options.

“So the goal of PA MEDI is that as soon as we do plan comparisons, at that point we stop and say, ‘We want you to call your doctors and specialists to make sure that your doctors, specialists and hospitals are part of the plans.’ are.’ That’s what we recommended,'” she said.

Financial savings programs and on-site enrollment support

People with low or limited incomes may be eligible for additional financial assistance and discounts that can be applied to their monthly Medicare premiums or deductibles.

According to the US Centers for Medicare and Medicaid Services, adults who qualify for Medicare savings programs can get help paying premiums as well as deductibles, coinsurance and copayments.

There is also some financial assistance specifically for Medicare Part D plans that cover medications and prescriptions.

The Extra Help program can reduce premiums and other costs and also eliminate late registration penalties for qualified candidates. According to CMS, some people will receive this assistance automatically, while others may need to apply.

Individuals interested in speaking with Medicare advisors for help and advice in choosing and obtaining insurance coverage can contact programs through their local State Health Insurance Assistance Program (SHIP).

In New Jersey, there are local SHIP offices in every county. Similar services and offices are offered in Delaware by the state’s Medicare Assistance Bureau. And in Pennsylvania, support and counseling through PA MEDI programs are available in most counties.