I’ve been writing about Medicare for years, so I wasn’t particularly affronted when, not long after my 64th birthday, I started receiving advertising circulars about Medicare, Medicare Advantage, and supplemental plans. Whether you are a newly enrolling senior or have been enrolled in Medicare for years, you do need to understand the system and the changes that happen nearly every year.

Where to start

Medicare’s confusion stems from its being cobbled together over the last 55 years by many political administrations. When approved by President Lyndon Johnson in 1965, it included only Part A (hospital) and Part B (doctor visits) coverage. In the 1980s, supplemental private insurance in the form of Medigap plans were offered to cover some of the deductibles and copays. The Medigap plans currently available in most states are A, B, D, G, K, L, M and N. Each plan offers a different level of coverage. Two other plans, C and F, are no longer available to new enrollees.

In the 1990s, Medicare Advantage (Part C) was offered as an entirely different way to access the Medicare system. Part C providers offer more services than original Medicare with the trade off of limiting your choice of medical providers. Whereas the focus of Medigap is covering the "gap" of deductibles and copays, Part C's focus is providing additional services such as vision and dental.

Your first decision, and the most important, is deciding whether to expand your upcoming Medicare coverage either through Medicare Advantage (Part C) or Medigap (supplemental Medicare). 

The best way to begin is with “Medicare & You: The Official U.S. Government Handbook,” available at www.medicare.gov. 

Drug coverage

Part D Drug coverage is different in an important way. Drug coverage began in 2003. Every year since then, the insurance companies tinker with their list of covered drugs. Because of this, every October, it’s a good idea to determine which plan is least expensive and most convenient for your menu of prescriptions. 

Unlike Medigap plans, you can choose a new drug plan each year with no penalty. One caveat is that if you require a new prescription during that year, you’ll be at the mercy of your current drug plan. 

When choosing your Medicare plan, start by asking your doctors and your friends what plan(s) they recommend. Perhaps the clinic or hospital with whom your doctor is associated only accepts one or two plans. If your friends have had good experiences with their plans, consider those. But understand that what works for your friends may not always work for you.

Still have questions?

You may still have a lot of questions after you’ve devoured the official handbook. For more information, contact your local State Health Insurance Assistance Programs (SHIP) for free, in-depth, one-on-one insurance counseling and assistance. In Mesa County, call 970-243-9839 ext. 1. In Montrose and Delta, call 970-765-3129. You can also contact a local Medicare insurance sales advisor.

Additional things to remember 

If you're approaching your 65th birthday, make some time for Medicare decisions.

• Your initial Medicare enrollment period begins the third month before your 65th birthday month and finishes at the end of the third month after your birthday month. That gives you seven months to make some pretty momentous decisions. 

• You can sign up later, at retirement, if your current coverage through an employer is at least as comprehensive as Medicare (“creditable coverage”). Otherwise, you may face a permanent financial penalty.

• Medicare's Annual Open Enrollment is October 15 through December 7 each year. During this time, current insureds can choose a new Medicare Advantage, drug or supplemental plan. Coverage starts annually on January 1.