Medicare Open Enrollment 2021: Essential Questions & Plan Choices

Medicare provides insurance for most seniors 65 and older, but getting covered isn't as simple as it may seem. In fact, you have a choice of Medicare plans, and the decision you make can affect the size of your premiums as well as the coverage available to you.

You can switch Medicare plans only during a specific time of the year, called open enrollment season, and that key time is coming up. In fact, it's starting Oct. 15, 2021, and will run through December 7. If you don't act during this time, you'll generally have to wait a full year before you can switch your coverage again.

Whether this is your first open enrollment period or you simply haven't shopped around for a Medicare plan for a while, here are a few key things you need to know about the decisions you'll need to make to find the best and most affordable coverage to meet your needs.

Do you understand original Medicare vs. Medicare Advantage?

Before you move on to the specific decisions you’ll need to make about your coverage, you’ll first need to understand the difference between original Medicare and Medicare Advantage.

Original Medicare refers to Medicare Parts A and B. It's administered by the federal government, with Part A providing coverage for hospitals and skilled nursing facilities and Part B providing coverage for your routine outpatient care. If you opt for original Medicare, your premiums, deductibles, coinsurance costs, copays, and all other terms of your insurance policy are set by the government. Plus, you don't have to shop around for a policy because there's only one original Medicare plan.

Medicare Advantage, on the other hand, is offered by private insurers. Also called Medicare Part C, Medicare Advantage plans are an alternative to traditional Medicare, but they still entitle you to all the coverage that original Medicare provides.

The big difference is that Medicare Advantage plans can also provide extra coverage, such as for dental care, which original Medicare doesn't cover. Many Advantage plans also offer prescription drug coverage, which you'd otherwise need to get by shopping around for yet another optional part of Medicare called Medicare Part D.

Medicare Advantage plans can have different out-of-pocket costs and can impose different rules for when you can get medical services. For example, an Advantage plan might require you to get referrals to see a specialist. There are also multiple different Medicare Advantage plans provided by different private insurers. This means you have a lot of options, but it can also complicate your shopping. You’ll want to thoroughly compare providers if you go the route of a Medicare Advantage plan.

There's no one right answer when it comes to deciding between original Medicare versus Medicare Advantage because a lot depends on your specific situation. So now let's look at some of the key factors that could affect your choice.