by Terri DeeIllinois News Connection
CHICAGO - Open enrollment for Medicare ends on Dec 7. The federal health insurance program is for anyone aged 65 or older. Some people younger than 65 with certain disabilities or conditions, limited income and resources can also get coverage. Health research organization KFF reports 43% of Illinoisans have Medicare Advantage and 57% opted for traditional Medicare coverage. Stephani Becker, associate director of health care justice at the Shriver Center on Poverty Law in Illinois, explained the program. "It covers inpatient care in hospitals, services from doctors and other health care providers, outpatient care, home health care, durable medical equipment and many preventive services," Becker outlined. "That's your Medicare Part A and Part B. Then there's a part D, which is a drug-coverage program." KFF also noted in 2025, Medicare beneficiaries will pay no more than $2,000 out of pocket for prescription drugs covered under Part D, Medicare's outpatient drug benefit, due to a provision in the Inflation Reduction Act of 2022. Another important distinction to know is the difference between the original Medicare and Medicare Advantage. Traditional Medicare does not cover dental, vision and hearing insurance. However, many Medicare Advantage programs do. Becker emphasized it is important to review all documentation carefully to understand exactly what is in private plan coverage. "One is the premium, which is what you pay monthly to your health insurance company," Becker pointed out. "Then the second is your out-of-pocket costs, so things like copays and coinsurance and deductibles, and that's the type of payment that you use when you use your insurance." JustPlainClear.com and MedicareMadeClear.com are good websites to explain various health care plans for members and caregivers. Becker adds someone who is self-employed and not eligible for Medicare can buy a plan for themselves on the marketplace and may be eligible for premium assistance. A slightly larger business with two or more employees, for example, can work with a broker and buy a small group health plan. Meanwhile, open enrollment dates vary for other types of health plans. People with employer-sponsored coverage typically select a plan during a two-to-three week period between September and December. And open enrollment for plans on the Health Insurance Marketplace generally runs from November 1 to January 15 in most states. More information is available at www.UHCOpenEnrollment.com.
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