The Doctor Will See You Now – Medicare Enrollment: Terms & Tips

By Mike Wallace, Vice President Growth & Strategy, Optum New Mexico

As inflation in the U.S. remains high, you may be looking to adjust your lifestyle and spending habits. When it comes to health care, it’s important to keep your budget and well-being in mind. Medicare’s Annual Enrollment Period, October 15 through December 7, is an opportunity to assess your overall care costs to help ensure you choose a plan that will work best for next year’s budget.

Below are four tips, including important terminology, to consider when choosing a plan that may help lead you to better health and cost savings:

  1. Consider all your options.Take time to understand and compare the benefits, services and costs of each plan available to you, so you can figure out which will be the best fit. Pay attention to more than just the monthly premium like out-of-pocket costs for which you may be responsible, including the deductible, copays and coinsurance.
  2. Learn the language. The process of choosing a Medicare plan can be challenging for many older adults and caregivers. Understanding the terminology can help guide you in the right direction.

Original Medicare is provided by the government and includes Part A, hospital coverage that helps pay for inpatient care, skilled nursing facilities, hospice care and home health care; and Part B, medical coverage that helps pay for outpatient services from doctors and other providers, preventive services and medical equipment like wheelchairs and walkers.

You can add a Medicare Advantage plan called Part C or a Medicare Supplement, also referred to as Medigap. Both plans are offered by private insurance companies approved by Medicare.

  • Medicare Advantage plans combine Part A and Part B coverage into one comprehensive plan. These plans often include prescription drug coverage (Part D) and offer benefits not provided by Original Medicare. These plans are suited for those who are generally in good health and don’t expect a great deal of medical expenses.
  • Medicare Supplement plans cover some of what Medicare Parts A and B do not cover, such as portions of coinsurance, out of pocket costs, copayments, and deductibles. These plans may be good for seniors who have significant health issues and out of pocket costs.

Some of the language associated with Medicare enrollment can be confusing, too. There are several enrollment periods depending on your unique situation.

  • Initial Enrollment Period: This period starts three months before the month you turn 65 and ends three months after the month you turn 65.
  • Annual Enrollment Period: This period runs from October 15 through December 7 each year and allows you to sign up for a plan, switch plans or leave a plan.
    • Special Enrollment Period: This period applies only to special circumstances; it allows you to make changes to your Medicare Advantage plan and prescription drug coverage when certain events happen in your life like moving or losing your coverage.
    • General Enrollment Period: This period from January to March allows you to enroll in Part A or Part B, but your coverage will not go in effect until July 1 of that same year. This period applies to individuals who forgot to enroll when first eligible or delayed enrollment for one reason or another.
  1. Help prevent financial surprises. Visiting doctors that are in-network is one way to help keep your costs lower. So before selecting a plan, check to see if your doctor is in your health plan’s provider network. Also, make sure your medications will be covered by the plan you choose next year — even if you don’t expect to change plans. Look into filling your prescriptions at a participating network pharmacy or with home delivery by mail — two more potentially money-saving options.

You may be surprised to learn that Original Medicare doesn’t generally cover prescription drugs. Consider adding Part D or enrolling in a Medicare Advantage plan with prescription drug coverage to help keep your medication costs in check.

  1. Consider specialty benefits. Original Medicare doesn’t cover most specialty services, but many Medicare Advantage plans do, and these benefits contribute to overall well-being.

As you navigate Medicare Annual Enrollment Period, the best advice is to avoid waiting until the last minute. Start early and give yourself enough time to make the decisions that will be right for you.


Learn about options that best fit your needs and enable you to continue seeing your preferred doctor by consulting an independent licensed insurance agent or health plan sales agent. They can also share options for coverage of unique needs, such as chronic conditions or alternative medicine. To get connected with a licensed insurance agent, call 1-505-456-0060.

For full information on enrolling in Medicare plans, you can review the CMS website at or call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/seven days a week.

Mike Wallace is also a licensed New Mexico health and accident insurance producer.

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