Medicare questions and answers

You can choose another plan during an enrollment period. For a change starting January 1, the usual fall enrollment window runs from October 15 through December 7. The new plan must receive your enrollment request by December 7.

First, ask your current insurer what happens if you do nothing. Is it moving members into a replacement plan, or is your coverage ending? Those situations can have different enrollment rights. A different plan name alone does not tell you which applies. Keep the letter and ask the insurer to identify the notice that explains your choices and dates.

Before accepting the replacement, check its January costs and coverage. Ask about your doctors and prescriptions using the new plan’s exact name. If it is employer or retiree coverage, check with the benefits office before changing it; a switch can affect benefits for you or your family.

It’s worth comparing your options. A smaller dental or vision benefit may change what you pay, but another plan could also change which doctors you can see or what your medical care costs.

Start with the Annual Notice of Change your plan sends in the fall. Look at the changes that affect care you actually use. Then compare:

• Your doctors and hospital, including whether they’ll accept the exact plan next year.
• Your prescriptions and pharmacy costs.
• Medical copays and the plan’s annual limit on your share of covered medical care.
• The dental and vision services you expect to use, including what you would pay yourself.

Ask the plan to show you the benefit details behind any advertised allowance. A dollar amount on a brochure does not answer whether your particular treatment is covered. Keep your current plan’s notice beside the alternatives so you’re comparing the same year.

You may have a one-time right to get it back if you dropped Medigap to join Medicare Advantage for the first time and return to Original Medicare within 12 months. This is called a trial right. Under that federal protection, you can return to your old policy if the same company still sells it. If it doesn’t, you may have a right to buy certain other Medigap policies.

There is a separate trial right for people who first joined Medicare Advantage when they became eligible for Medicare at 65. The rules are not the same as having unlimited chances to switch back and forth.

For a trial right, you can generally apply for Medigap from 60 days before your Advantage coverage ends through 63 days afterward. Confirm your dates with the insurer.

Before dropping anything, ask the Medigap company to confirm which right applies, which policy it will issue, and the start date. Outside a protected period, an insurer may use your health history when deciding whether to accept you. State law can give you additional rights. Also confirm when you can leave Advantage and arrange any separate drug coverage you need.

You may be able to wait on Part B if your insurance comes from your or your spouse’s current job. Having a job by itself isn’t enough; the type of insurance and which insurer pays first matter.

For someone 65 or older, a current-employment group plan generally pays first when the employer has 20 or more employees. With fewer than 20, Medicare generally pays first. Multi-employer arrangements can have different rules. Ask your benefits office: “Will this plan pay my claims properly if I don’t enroll in Parts A and B at 65?”

Check prescriptions separately. Ask whether the employer’s drug coverage is creditable, meaning it meets Medicare’s standard for delaying Part D, and keep the notice confirming that. If you contribute to an HSA, check your Medicare start date before signing up for Part A; enrollment can affect what you’re allowed to contribute.

You may need to correct excess HSA contributions. Check the Part A start date on your Medicare record first; it can be earlier than the day you applied. Social Security says Part A can start up to six months before the application month when you enroll after 65.

Your HSA contribution limit is zero for months you’re enrolled in Medicare, including retroactive months. Work out the allowed contribution for the year, counting both your contributions and your employer’s. Don’t assume every dollar deposited recently is necessarily the amount to remove.

Ask your HSA administrator about its process for returning an excess contribution and the related earnings. IRS rules generally let you avoid the 6% excise tax on the amount corrected if you withdraw the excess and its earnings by the tax-return deadline, including extensions. The earnings must be reported as income.

Give the administrator or tax preparer your Medicare effective date and contribution records. Ask them to calculate the correction before making a withdrawal; an ordinary withdrawal is not a substitute for checking the excess-contribution rules.