KFF Explains Medicare Parts C and D: Do You Need to Enroll During Open Enrollment?

I have Medicare Part A and Part B. I’ve heard about Part C and Part D, but I don’t know what those are. Do I need to sign up for those during the Medicare Open Enrollment period?

Medicare Part C, also called Medicare Advantage, is private health coverage for people who are enrolled in Medicare. These plans are usually HMOs or PPOs. If you join a Medicare Advantage plan, you still have Medicare, but your Medicare-covered benefits are delivered through the private plan. Many Medicare Advantage plans also include prescription drug coverage, and most offer extras such as vision, dental, and hearing benefits. If you already have Part A and Part B and are using traditional Medicare, you do not have to enroll in Medicare Advantage during Open Enrollment unless you want to receive your Medicare benefits through a private plan.

Medicare Part D is the prescription drug benefit offered through private stand-alone drug plans, often called PDPs, as well as through Medicare Advantage plans that include drug coverage. If you have traditional Medicare and want prescription drug coverage, you can sign up for a stand-alone drug plan during the Medicare Open Enrollment period. If you did not enroll in a Part D plan when you got Part A and Part B, and you do not have other drug coverage that is at least as good as Part D, you may owe a late enrollment penalty. After you are enrolled in a Part D plan, you can change drug plans during Open Enrollment.

To compare Medicare Advantage and Part D plans available in your area, you can use the Medicare coverage comparison tool on Medicare.gov. You can also call 1-800-MEDICARE (1-800-633-4227) or contact your local State Health Insurance Assistance Program, known as SHIP. SHIPs provide local, individualized counseling and help for people with Medicare and their families. Call 877-839-2675 to find the SHIP phone number for your state.

Other KFF Medicare Q&A topics include whether you can switch from your current Medicare Advantage or Part D plan to a plan with a 5-star quality rating outside Open Enrollment, how recent Medicare changes may help lower prescription drug costs or spread them over the year, and whether you need a drug plan if you do not take any medications.

Although every effort has been made to ensure these FAQs are accurate and current, people should contact Medicare, Social Security, SHIP, or the companies that offer Medicare Advantage, Medicare Part D, and Medigap plans directly for advice on their own situations.

Source: KFF