Insurance and Medicare

Whether you’re planning your switch to Medicare from your current health insurance plan, or you’re an experienced Medicare beneficiary, it’s important to understand your options when it comes to your health coverage. Medicare is government-sponsored health insurance for people ages 65 and older, younger individuals with disabilities, and people with End Stage Renal Disease (ESRD). There are a number of Medicare plans to choose from to get the right coverage for your unique needs.

Before you choose your plan, It’s helpful to know more about the open enrollment process, how to change primary care physicians when you switch to Medicare, and the types of health insurance plans accepted by Iora. You can also talk to your care team about what to look for in a plan during your next primary care visit.

Common Medicare Enrollment Periods

There are two enrollment periods to keep in mind as you approach Medicare age. Your Initial Enrollment Period will be your first opportunity to enroll in Medicare and is based on your date of birth. The Medicare Annual Open Enrollment Period is your annual opportunity to review your coverage and make changes. Both are outlined below.

You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs). For more details on those Special Enrollment Periods visit Medicare.gov.

Initial Enrollment Period

If you’re eligible for Medicare when you turn 65 and are enrolling for the first time, you will have a 7-month Initial Enrollment Period (IEP) to sign up for Part A and/or Part B. You can also choose your additional coverage at this time. Your Initial Enrollment Period begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you were born in May, for instance, your IEP will begin in February and end in August.

Medicare Annual Enrollment Period

Open enrollment takes place from October 15 – December 7 each year. During this time, you can:

Sign up for a new Medicare plan
Switch from Medicare to Medicare Advantage (MA)
Add a Medicare Part D plan to your current Medicare coverage
Add a Medicare supplement plan to your current Medicare coverage (not applicable for Medicare Advantage plans)

All changes go into effect on January 1 of the upcoming year. Be sure to review your plan each year, as plans change annually and the plan that worked for you one year may not be your best option in the following year.

If you do not choose a new plan during open enrollment, your existing coverage will continue into the following year. If you did not have previous coverage, you could be subject to a surcharge and pre-existing conditions may not be covered by your provider in the future, so it’s important to start planning before you turn 65.

How to Change Medicare Plans

Medicare benefits vary from year to year, so be sure to review your Medicare plan materials annually to ensure that your current plan still meets your needs. You can look over each year’s Medicare plan at the beginning of October, or we strongly recommend discussing your Medicare options with an insurance agent.

As you re-evaluate your coverage each year, you may find that you need to change your plan during open enrollment in order to:

Keep certain benefits
Get a higher quality plan, such as a 5 star plan, if you are currently on a 3 star plan or below
Swap your Part D plan to Medicare Advantage in order to keep your in-network provider

Whether you’re already working with a local Medicare agent, have questions about how to find a Medicare agent, or have questions about your options, you can contact our patient enrollment coordinators for assistance. At Iora Primary Care, we work as a team to help you get the most from your insurance plan.

What If I Missed the Open Enrollment Period?

If you missed open enrollment in the fall, you still may be able to enroll in a different plan during the Medicare Advantage Open Enrollment Period (MAOEP), which runs annually from January 1 – March 31. During MAOEP, beneficiaries who already have a Medicare Advantage plan can switch insurance providers and enroll in another MA plan.

During MAOEP, you can also disenroll from your current plan and revert to Original Medicare, with the option to enroll in a Part D prescription drug plan.

If you don’t have a Medicare Advantage plan and still have questions about how to change Medicare plans, talk to your insurance agent about choosing a Medicare plan that’s best for you.

Learn More About Changing Your Medicare Advantage Plan

How to Change Your Primary Care Physician on Medicare

There are a number of reasons to consider switching primary care providers, such as changes in your insurance, practice location, level of service, communication, or if your current provider’s practice is closing or moving. You may also want to find a primary care provider that focuses on the needs of seniors, where preventive and coordinated care becomes crucial to your health.

At Iora, your health is our top priority—we focus our efforts on getting to know you and your unique needs, so we can identify and treat health concerns early on. Our coordinated care approach also helps our providers get a full picture of your health inside and outside the practice. We collaborate with you, your family, and other specialists and hospitals to listen, support, and find the best treatment plan for you.

The good news is, if you receive coverage through Medicare Part B, you can go to any Medicare-participating physician or healthcare provider that is welcoming new patients. If you have a Medicare Advantage plan, you may have a specific network of doctors that are available to you. At Iora, we’re dedicated to providing exceptional care to adults 65 and older on Medicare, and our patient enrollment coordinators are here to help you learn more about how to change primary care physicians.

Iora Primary Care has practice locations in Arizona, Colorado, Georgia, Massachusetts, North Carolina, Texas and Washington. If you are ready to change your Medicare primary care provider, find an Iora location near you.

Types of Health Insurance Plans
Accepted by Iora

Adults on Medicare are not limited to one option when it comes to health insurance, and many seniors opt to have more than one plan in order to get all the coverage they need. Iora Primary Care accepts the following Medicare plans:

Medicare

Government-sponsored health insurance available to most people when they turn 65. Original Medicare consists of Parts A and B, and many participants opt to add Part D to their plan as well. Medicare is accepted at all Iora Primary Care practices, and consists of one or more of the following parts:

Part A is automatic and includes payments for treatment in a medical facility, such as a hospital stay.
Part B is automatic if you do not have other healthcare coverage, such as through an employer or spouse, and covers outpatient medical services.
Part C also called Medicare Advantage, is an alternative to traditional Medicare, offered by private health insurance companies.
Part D covers prescription drug benefits.

Learn More About How to Sign Up For Medicare

Medicare Advantage

All-in-one plans that serve as an alternative to Original Medicare (Medicare Parts A and B). These plans are offered by private insurance providers and often come with additional benefits, such as vision and hearing, prescription drug coverage, or gym memberships. The following Medicare Advantage insurance providers are accepted at Iora Primary Care practices:

Arizona (Phoenix) – Aetna, AllWell, Cigna, Devoted Health, and Humana
Arizona (Tucson) – Aetna, AllWell, Cigna, and Humana
Colorado – Cigna, Humana and UnitedHealthcare
Georgia – Aetna, Cigna, Humana, UnitedHealthcare, and Wellcare

Massachusetts – Blue Cross Blue Shield MA, Tufts Medicare Preferred HMO and UnitedHealthcare
North Carolina – Blue Cross NC, Cigna, Humana, UnitedHealthcare, and Wellcare
Texas – Aetna, Cigna, Devoted Health, Humana, and Wellcare
Washington – Humana and UnitedHealthcare

Insurance FAQ

Do I need a primary care provider with Medicare?

While not all Medicare Advantage plans require this, some Medicare Advantage plans will require you to select a primary care doctor, so be sure to check the details of your plan. However, it is important to have a primary care doctor when you are over 65 to stay healthy and active in your daily life, even if it is not required by your insurance. Your primary care provider can help you identify health concerns that develop as you get older, work with you to form a treatment plan that fits your unique needs, and provide expert advice on how to protect your health and feel your best in your daily life.

Do you need a primary care doctor with Medicare? Your health is our top priority — become a patient and learn how Iora can help you live your healthiest life.

What is the Medicare Special Enrollment Period?

The special enrollment period (SEP) allows you to make changes to your Medicare Advantage and Medicare prescription drug coverage when certain qualifying events happen in your life, such as:

Loss of other insurance coverage
Moving
Changes in your plan’s contract with Medicare

Can I choose my Iora Primary Care Provider?

If you have a Medicare Advantage plan, check the list of insurances accepted by Iora to make sure you are on a plan we accept within your area. If you are not currently on a plan we accept in your area, remember that the Medicare Annual Open Enrollment Period is your next opportunity to change your coverage. If you are on Medicare with no secondary coverage, you can visit any Iora Primary Care provider.