Civic Coffee Recap: Medicare Open Enrollment

The Medicare Open Enrollment Period (OEP), the annual window for beneficiaries to review and update their coverage, ends Dec. 7. Back in October, when the OEP had just begun, Age Friendly Seattle hosted its monthly Civic Coffee at the Neighborhood House-High Point in West Seattle to discuss the process and provide information to those already enrolled in Medicare and considering plan changes for 2025.

The event’s special guest speaker was Sam Stones, Statewide Health Insurance Benefits Advisors (SHIBA) Program Lead at Solid Ground, a Seattle-based nonprofit organization committed to ending poverty and addressing racism and other oppressions that contribute to poverty. Its SHIBA program provides free, unbiased, and confidential assistance to Washington state residents with Medicare and health plan options.

Medicare is a federal health insurance program available for individuals who meet the following criteria:

• Age 65 and older
• Under age 65 with a disability, as determined by the Social Security Administration
• Diagnosed with End-Stage Renal Disease or Lou Gehrig’s Disease (ALS)
• Citizen or Legal Permanent Resident for at least five continuous years

During the OEP, Medicare enrollees can make changes to Original Medicare, Medicare Advantage (MA), and Medicare Part D prescription drug plans. For many, the OEP may be the only opportunity to adjust MA and prescription drug coverage for the upcoming year.

Stones emphasized the importance of reviewing plans, as coverage details and costs often change annually. A plan that meets your needs this year might not provide the same benefits next year, so reviewing your options ensures your coverage aligns with your health needs and budget.

Click on the image above to watch a video recording of the Civic Coffee on Medicare OEP (YouTube, 44:35).

Tips for Researching Medicare Plans

He offered three essential tips for researching Medicare plans:

1. Stay Organized — Keep a dedicated notebook for taking notes and save copies of any paperwork you receive.
2. Document Important Conversations — Record names, dates, and contact information for Medicare or health-related inquiries.
3. Be Cautious of Fraud — Be especially vigilant during OEP. Medicare will only call you if you’ve requested contact, so be cautious of unsolicited calls.

A Refresher on Medicare’s Four Parts

Stones reviewed the four main parts of Medicare:

• Part A: Hospital Insurance — Covers inpatient hospital care, skilled nursing facility care, hospice, and some home health care. It’s generally premium-free for those with at least 10 years of work credits.
• Part B: Medical Insurance — Covers outpatient care, doctor visits, and preventive services. It typically has a monthly premium, estimated around $185 though this amount can vary.
• Part D: Prescription Drug Coverage — Covers prescription drugs, with costs that vary by plan. Many people add Part D to their coverage to manage medication expenses.
• Part C: Medicare Advantage — An all-in-one alternative to Original Medicare, combining Parts A and B, and often Part D. These plans, provided by private insurers, may also offer extra benefits like dental, vision, and hearing coverage.

Choosing the Right Plan for You

Choosing a Medicare plan can be daunting, but Stones outlined a few key steps to simplify the process. Start by comparing available plans using the Medicare Plan Finder. Consider factors like cost, prescription drug coverage, and provider networks. For Medicare Advantage plans, verify that your preferred doctors, hospitals, and pharmacies are within the plan’s network and that the plan offers competitive prices.

For questions about plan details, enrollment, or specific coverage issues, Stones recommends contacting Medicare directly at 1-800-MEDICARE or visiting www.medicare.gov. Washington’s SHIBA program is also available for personalized guidance at 1-800-562-6900.

For those needing extra support to cover Medicare costs, several programs are available. Stones encouraged lower-income beneficiaries to explore resources like the Medicare Part D Extra Help program through the Social Security Administration and the Medicare Savings Program (MSP), accessible through Washington Connection.

Important Changes to Medicare Part D for 2025

Stones highlighted significant changes coming to Medicare Part D in 2025:

1. Elimination of the Donut Hole — Medicare will no longer have a coverage gap phase where beneficiaries pay more after reaching a spending threshold.
2. Annual $2,000 Cap — A new cap will limit out-of-pocket expenses for covered medications.
3. Prescription Payment Program — This new program allows enrollees to spread out prescription costs throughout the year, rather than paying large sums up front.

Contact SHIBA for Medicare Assistance

SHIBA volunteers provide free, unbiased, one-on-one counseling to help answer Medicare questions and support decision-making. Due to a high call volume, SHIBA currently has a two-week wait time. Once you make an initial call, a SHIBA representative will follow up with you within two weeks. You can reach out to them through any of the following methods:

• Phone (Solid Ground SHIBA Intake Line): 206-753-4806
• Email: shiba@solidground.org
• Website: solid-ground.org/get-help/medicare-info/
• For more information on other Solid Ground programs: 206-694-6700

Contributor Reese Wohrle is an intern with Age Friendly Seattle. He is studying Community, Environment, and Planning at the University of Washington’s School of Built Environments.