PUBLISHED
THU, OCT 17 20191:16 PM EDTUPDATED FRI, OCT 18 20198:52 AM EDT
KEY
POINTS
·
Of Medicare’s 60
million or so beneficiaries, 22.4 million are expected to be enrolled in
Advantage Plans in 2020.
·
Even if your coverage
worked well this year, the specifics of your plan might be changing or another
option may now be more suitable.
·
Be sure to look beyond
premiums and instead consider your total out-of-pocket spending, no matter how
you get your coverage.
Even if Medicare’s open enrollment period sounds
like a big snore fest, you might sleep better next year if you take advantage
of it.
For the program’s 60 million beneficiaries, that
yearly fall window — Oct. 15 through Dec. 7 — offers the chance to make changes
that take effect Jan. 1. While you aren’t required to do anything — your
coverage will automatically renew if you take no action — passing on the chance
review your plan could cost you in 2020.
“The danger is that at the time of service,
you’ll be surprised when you have a different copay or out-of-pocket expense
that you weren’t anticipating,” said Elizabeth Gavino, founder of Lewin &
Gavino in New York and an independent broker and general agent for Medicare
plans.
During this annual fall enrollment period, you
can:
·
Switch to an Advantage
Plan from original Medicare (Part A hospital coverage and Part B outpatient
coverage);
·
Switch to original
Medicare from an Advantage Plan;
·
Move from one Advantage
Plan to another;
·
Move from one
prescription drug plan (Part D) to another, or purchase one if you did not when
first eligible (although you could face a penalty for late enrollment).
Of the 60 million or so Medicare beneficiaries,
roughly 22.2 million people are enrolled in Advantage Plans, according to the
Centers for Medicare and Medicaid Services. That number is expected to rise to
24.4 million in 2020.
The remainder are on original Medicare and often
pair it with a standalone drug plan and/or a so-called Medigap policy. Be aware
that generally speaking, autumn open enrollment has nothing to do with Medigap
plans, which operate under separate rules.
Here are mistakes to avoid when it comes to the
current six-week window to make changes.
Ignoring the whole thing
Even if your Advantage plan or drug coverage
served you well this year, there’s no guarantee that you’ll feel the same way
in 2020.
While insurers are federally regulated, the
specifics of their options can vary greatly from plan to plan, county to county
and year to year. Changes can affect your premiums, deductibles, co-pays and
covered services, along with participating doctors, hospitals, pharmacies and
other providers.
The average monthly premium among Advantage
Plans is forecast to be $23 next year, down from close to $27 in 2019. This
year, 56% of enrollees paid no premium for those plans, according to the Kaiser
Family Foundation.
Regardless of what that payment would be, keep
in mind that it’s in addition to your Part B premium. Although there’s been no
official word yet on that base amount for 2020, it’s projected to rise to
$144.30 from $135.50 this year, according to the latest Medicare Trustees
report. (Higher-income beneficiaries pay more.)
Of course, premiums are are not the only factor
you should consider.
“The lower premiums have higher deductibles and
copays, and the higher premiums tend to have lower amounts for those,” said
Danielle Roberts, co-founder of insurance firm Boomer Benefits in Fort Worth,
Texas. “Look at what it will cost you overall.”
The average out-of-pocket limit for in-network
services among Advantage plan enrollees in either HMOs or PPOs this year is
$5,059, according to the Kaiser Family Foundation.
“You should know your worst-case scenario and be
prepared to afford the maximum out-of-pocket for the plan you choose,” Gavino
said.
You should know your
worst-case scenario and be prepared to afford the maximum out-of-pocket for the
plan you choose. Elizabeth Gavino Founder Of Lewin &
Gavino
Monthly premiums for standalone prescription
drug plans will also be lower next year, dropping to $30 from $32.50 in 2019.
(Again, higher earners pay more.)
However, as with Advantage Plans, a lower
premium doesn’t necessarily mean your total out-of-pocket cost would be less.
Depending on the plan’s formulary — how it
prices the drugs it covers — and the coverage restrictions in place, the amount
you pay for certain drugs could be more in 2020.
You can compare coverage through the
Medicare.gov Plan Finder tool, although be aware that
some of the information you’re given may be incomplete. You might have to look
at the plan’s formulary to get details on things like whether you’d have to try
out cheaper alternatives first (so-called step therapy) or if there are
quantity limits on the medicine you take.
To make sure your doctor, pharmacy or other
provider is still in network, you also have to check with the insurance company
that offers the plan. You can either visit the provider’s website or call. And
if you work with a Medicare agent, that person also should be prepared to help
you.
Assuming there’s no better option
The number of Advantage plans you can pick from
largely depends on where you live. The more rural the area, the fewer the
options you’re likely to have. For example, in Wyoming and Alaska, fewer than
10% of all beneficiaries are in Advantage plans in 2019, according to the
Kaiser Family Foundation. Nationwide, that share is more than 30%.
However, new plans continuously become
available, as insurance carriers expand their options and coverage areas and
new players enter the market. This makes it important to make sure there isn’t
a more cost-effective option for you.
New stand-alone prescription drug plans also
could be available where you live, which makes it worthwhile to
comparison-shop.
“Your plan might be great, but if one similarly
priced saves you $500 next year, you’d probably want to know about that,”
Roberts said. “If you don’t do the analysis, you might miss out on that
savings.”
Assuming your health won’t change
If your health is good, that’s great. If you
assume it will never go downhill, that might not be so wise.
Remember, original Medicare doesn’t cover everything. While
everyone’s situation is different, it’s important to at least consider the
unknown.
For example, while you might take no medicine
now, there’s a good chance that will change, whether due to aging, an accident
or an unanticipated medical event.
More than 80% of people age 65 and older take at
least two prescription drugs and more than 50% take four or more, according to
an AARP survey in 2016.
In other words, it can be worthwhile making sure
your coverage accounts for the unexpected.
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