Everything
you need to know to make the most of this year's open enrollment period
by Walecia Konrad | October 11, 2018
It’s that time of
year again: From October 15 through December 7, the 44 million Americans
enrolled in Medicare will
perform their annual dance of checking plan features, looking up covered drugs,
calculating premiums—and maybe even changing partners.
This seven-week
Medicare open enrollment window is your once-a-year chance to re-do
your coverage, which could mean switching from one Medicare Advantage plan to another, picking a new prescription
drug plan, or moving from Original Medicare to Medicare Advantage (or vice versa).
Even if you are happy
with what you have, open enrollment matters: You may be facing changes to your
plans, not to mention changes to your health.
“The difficult thing
about Medicare is, when you really scratch the surface, the only way to really
be successful is to do some homework,” says Philip Moeller, author of Get What’s Yours for Medicare:
Maximize Your Coverage, Minimize Your Costs. “What’s good for
you may not be good for your neighbor or even your spouse.”
This is your
opportunity to make sure you have the best fit for the coming year and
beyond—at the best price you can find. Here’s how to do that.
Know what’s on the
table
Before you can make
any changes to your game plan, you need to be familiar with all of the
players.
Original Medicare
consists of Part A to cover hospitalizations and Part B for physician and outpatient services. You pay a
deductible, co-pays, and a monthly premium, which will be $135.50 a month in
2019 for most people.
With Original
Medicare, you typically need to buy a Medicare Part D plan from a private insurer to cover
prescription drugs. In 2019, average monthly Part D premiums are expected to
decline a bit, from $33.59 to $32.50, according to the Centers for Medicare and
Medicaid Services (CMS).
Plus, you may want a
separate Medicare Supplement policy—also known as Medigap—to cover what
Original Medicare omits. Depending on your plan choice, your age, and where you
live, you could pay between $100 and $250 a month.
Medicare Advantage
plans, which are sold by private insurers as an alternative to Original
Medicare, wrap all or most of that coverage into one policy. The plans cover
everything Parts A and B do, plus offer additional benefits, such as dental and
vision insurance.
The average Medicare
Advantage premium, which is on top of your Original Medicare premium, is
expected to decrease slightly to $28 a month, according to CMS.
How your coverage
could change
If you’re signed up
for Original Medicare, don’t be lulled into thinking you have nothing to do.
You still need to review your prescription drug coverage, and perhaps give
Medicare Advantage a fresh look.
Part D plans are
constantly shifting. So check to see if your plan’s list of covered drugs
(what’s called a formulary) will continue to include the medicines you need. Look at Part D
plans here.
If you’re signed up
for Original Medicare, don’t be lulled into thinking you have nothing to do
Also, find out if
your insurer is adding any new restrictions, such as prior authorization,
quantity limits, or step therapy, which requires you to try generic and other
lower-cost drugs before the most expensive medication can be prescribed.
With a Medicare
Advantage plan, prescription drug coverage is typically included, so the same
review applies. Plus, don’t assume your other plan benefits will stay the same.
Where to dig up plan
updates
Now’s the time to
unearth the junk mail you probably threw in the corner weeks ago. Anyone with a
Medicare Advantage or Part D policy should have been mailed an Annual Notice of
Change, a roughly 10-page document that outlines all the ways your plan will be
different in 2019.
Now’s the time to
unearth the junk mail you probably threw in the corner weeks ago
Insurers must also
make available a document called the Evidence of Coverage (EOC). As of this
year carriers don’t have to mail you this 140-plus-page booklet. Instead, they
must make the EOC available on their websites by October 15.
In addition, you
should have been mailed a Notification of Electronic Materials, which tells you
what you can find online, such as lists of covered drugs and provider
directories, and how you can obtain paper copies.
Anything missing?
Call your insurers and ask them to resend the material.
What to look for in a
new plan
As you compare prices
and coverage for all the Medicare options in your area, pay attention to these
features:
Networks. The main difference
between Medicare Advantage and Original Medicare comes down to the providers
you can see.
Under Original
Medicare, you may visit any doctor that accepts Medicare, and many do. To keep
costs down and be able to offer extra benefits, Medicare Advantage plans
usually limit you to a smaller network of providers.
See what the
out-of-network costs will be if one of your doctors leaves your network
For any Advantage
plan you are considering, including your current one, check the list of providers
to make sure your doctors and other health care professionals will be
in-network in 2019. That includes hospitals, home health agencies, and skilled
nursing facilities.
Out-of-pocket costs. In addition to
checking premiums, you’ll also want to look up the co-pays or co-insurance for
primary care doctors and specialists. And see what the out-of-network costs
will be should one of your providers leave the network.
Covered drugs. Just as you have
reviewed which drugs are covered for your current Part D or Advantage plan, you
want to review the formularies and restrictions for every policy you are
considering.
Additional benefits. You may be
gravitating toward Medicare Advantage because of the dental and vision
coverage. Be sure to read the fine print about these extras so you understand
any limitations.
In addition, Medicare
Advantage plans are undergoing a substantial expansion. Private insurers may now cover
non-medical items such as bathroom grab bars, transportation to medical
appointments, and other types of assistance.
These rule changes
are very new, so you won’t see the additions in most plans this year, according
to Moeller. But wider changes are expected in 2020.
Why you should pause
before you switch
As you explore your
options, keep one caveat in mind. During open enrollment, it’s easy to move
from one Medicare Advantage plan to another, change your stand-alone Part D
prescription plan, or switch from Original Medicare to Medicare Advantage.
If
you don’t sign up for a Medicare Supplement plan within six months of when your
Medicare Part B plan kicks in, insurers can later deny you coverage
What’s trickier,
however, is moving from Medicare Advantage to Original Medicare. That’s because
in all but four states, if you don’t sign up for a Medicare Supplement policy
within six months of when your Medicare Part B plan kicks in, insurers can
later deny you coverage based on a preexisting condition, such as asthma, heart
disease, diabetes, or a pending surgery.
“Lots of very smart
people don’t understand this basic fact of Medicare,” says Judith Stein,
executive director of the Center for Medicare Advocacy.
So switching to an
Advantage plan could potentially eliminate the option of returning to Original
Medicare with a supplemental policy later.
Why you need one more
check
It’s decision time.
If you’ve found a plan you like, you’re ready to make the switch. Before you
do, however, take one more step.
If you’ve done the
bulk of your research online, call the plans you are considering and see if
there have been updates to the premiums and plan features that haven’t been
posted online.
And keep in mind, if
you choose a Medicare Advantage plan, new rules this year allow you to switch to a different one or go back to Original Medicare
through March of next year.
Congratulations,
you’ve made it through another Medicare open enrollment dance. With a little
effort and a lot of good information, you can find a partner that matches your
needs step for step.
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