Choosing the right Medicare plan involves navigating available options and deciding on the coverage that best suits your needs. Upper Peninsula Health Plan (UPHP) offers the residents of Michigan’s Upper Peninsula one Medicare-Medicaid option from our local, Upper Peninsula-based organization.
- Since 1965, Medicare insurance has helped millions of Americans pay for the health care services they need. You likely have already paid into the program through Social Security.
- Medicare is a health insurance program for:
- People age 65 and older
- People under 65 with certain disabilities
- People of any age with end-stage renal disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)
Medicare has specific enrollment periods when you can sign up. Each has a particular purpose. Most people sign up during their Initial Enrollment Period, but it’s good to know about all the time periods and what they’re for.
- Initial Enrollment Period (IEP) – three months before, the month of, and three months after your 65th brithday.
- Annual Enrollment Period (AEP) – also called open enrollment, this period runs each year from Oct. 15 through Dec. 7. During this time:
- Anyone with Medicare Parts A and B can switch to a Part C plan or vice versa.
- Anyone who has or is signing up for Medicare Parts A or B can join, drop or switch to a Part D prescription drug plan.
- Anyone with a Part C plan can switch to a new Part C plan.
- Special Election Period (SEP) – there are special circumstances when you can enroll in Medicare outside of IEP or AEP. Some examples of situations where you may qualify for an SEP include, but are not limited to:
- Moving out of your current Medicare plan’s service area.
- You get Extra Help with your Medicare prescription drug costs.
- Your current Medicare plan leaves the Medicare program.
- You are eligible for Medicaid coverage (or lose your eligibility).
- Open Enrollment Period (OEP) – if you didn’t sign up when you were first eligible, or if you aren’t eligible for a SEP, you can sign up during the OEP between Jan. 1 and March 31 of each year.
Part A: Hospital Coverage
- Inpatient hospital stays and skilled nursing facility stays
- Hospice and respite care
- Home health care and religious nonmedical health care institution
Part B: Medical Coverage
- Doctor visits
- Outpatient care
- Services not covered by Part A, such as physical therapy
- Some home health care services, in some cases
- Some preventive services
- Durable medical equipment
Part C: Medicare Advantage
These plans are Medicare approved, but are offered by private insurers, like UPHP. They combine Parts A and B – and often Part D prescription drug benefits – into one plan. Medicare Advantage plans:
- Operate much like traditional health insurance you may have had through an employer.
- May also offer supplemental benefits not offered under Original Medicare, such as vision, dental, hearing and/or health and wellness programs.
- Typically have a network of providers you can see that contract with the plan to provide services.
Before you can join a Medicare Advantage plan, you must already have Medicare Parts A and B and live in the plan’s service area. Other eligibility requirements may apply.
Part D: Prescription Drug Coverage
If you have Medicare Parts A and/or B, Part D plans can be purchased separately to help cover your prescription drug costs. These plans are offered by Medicare – approved private insurers – so costs and covered drugs vary from plan to plan.
- Part D works with a Medicare supplement insurance plan, or on its own.
- You can also get Part D benefits through some Part C plans (like UPHP’s Medicare Advantage Plans).
Page Last Updated: 02/26/2024