BY ROCHELLE KOFF SPECIAL TO
THE MIAMI HERALD OCTOBER 16, 2019 03:13 PM
Open Enrollment deadline
to register for healthcare coverage through Medicare or the Health Insurance
Marketplace is approaching. Here are a few facts about enrolling and where you
can go for more information.
There’s one thing you can count on when you’re
dealing with Medicare. By the time you figure out the system, it will change.
That’s the cautionary message of many a government administrator, beneficiary
and volunteer —- and there are indeed more changes coming, starting on Jan. 1.
The major differences will primarily impact
those who are new to the government health insurance program. People new to
Medicare are those who turn 65 on or after Jan. 1, and those who first become
eligible for Medicare benefits due to other factors such as disability or end
stage renal disease on or after Jan 1.
The MACRA or Medicare Access and CHIP
Reauthorization Act, signed into law in 2015, includes revisions that will take
effect in all states.
As of March, 38 million people were enrolled
nationwide in the “Original Medicare” program and nearly 23 million enrolled in
Medicare Advantage or other Medicare health plans — about 61 million in the
country, said Anne Chansler, statewide program director for SHINE and Senior
Medicare Patrol.
SHINE stands for Serving Health Insurance
Needs of Elderly, a nonprofit program run by the state Department of Elder
Affairs and the Florida Area Agency on Aging. About 500 volunteers statewide
help residents navigate the Medicare program through SHINE. There’s a big need
for help in Florida. As of 2015, there were an estimated 4.8 million residents
60 and over in the state.
As you navigate Medicare, know the basics:
Original Medicare (Part A) covers hospital-based care. If you’ve worked and
paid taxes for at least 10 years, you won’t have to pay a monthly premium for
Part A, although there is a deductible.
Part B of Original Medicare covers visits to
your doctor’s office, outpatient care, preventive services and medical
supplies. This part does require a monthly premium and deductible. The 2020
cost of Part B premiums “will be released later this year,” said a spokesman
for the Centers for Medicare & Medicaid Services or CMS.
Medicare Parts A and B don’t cover all a
person’s needs such as routine dental care, eyeglasses, hearing aids,
prescription drugs and longer periods of rehab, so most people buy supplemental
insurance. Medicare Supplement Insurance policies are also called Medigap
policies. Every Medigap policy must follow federal and state laws and they’re
identified by different letters.
The big change coming is that Medigap Plans C
and F will no longer be available to people new to Medicare starting on Jan. 1.
That’s because both those plans covered the Part B deductible, which is $185 in
2019. Medigap Plan C did not cover excess charges but Medigap Plan F did cover
100 percent of a person’s medical bills, both the copays and the $185
deductible.
Congress, in passing that 2015 law, figured
that if you had people paying an out-of-pocket deductible, they would be more
judicious in using Medicare.
“Right now, the Medigap ‘F’ policy covers
everything a Medigap Supplement could cover,” said Kathleen Sarmiento, SHINE
liaison for the Alliance for Aging. “It’s the Cadillac of the supplement plans
and it’s going away.”
Anyone enrolled in a Medigap Plan C or Medigap
Plan F as of Dec. 31, 2019, will be “grandfathered” in and will be able to
continue with their plan, Sarmiento said.
For those newly enrolled, they will have to
seek another Medigap coverage plan.
New applicants are likely to consider Medicare
Supplement Plan G, which has the same basic benefits as Plan F, except the
person would have to pay the Part B annual deductible starting Jan. 1. The Plan
B deductible is expected to increase to $197 for 2020.
Changes to the Medicare system primarily
impact people who are covered under Original Medicare, said David Bruns,
Florida AARP director of communications. The Medigap plans work in tandem with
Original Medicare.
MEDICARE ADVANTAGE PLANS
Medicare Advantage is another way to get
Medicare coverage and includes Health Maintenance Organizations, Preferred
Provider Organizations, Private Fee-for-Service and Special Needs Plan
coverage. It incorporates both Medicare A and B.
Four of 10 Floridians 65 and older are on
Medicare Advantage, said Bruns.
DRUG PLAN CHANGES IN 2020
Prescription drug costs will also be impacted
in 2020. One change to Plan D, the prescription drug Medicare plan, involves
the so-called “donut hole.”
Medicare.com explains that the coverage gap or
“donut hole” begins when you exceed your plan’s Initial coverage limit. This is
the portion of your Medicare Part D coverage where you pay a larger percentage
of the retail drug cost.
The 2019 Donut Hole discount is 75 percent for
brand-name drugs and 63 percent for generic drugs. Beneficiaries currently pay
a 25 percent copay for brand-name drugs and 37 percent for generic drugs, but
under the new changes the copay for generic drugs will be reduced to 25
percent.
Under Medicare Part D, the drug plan, when
individuals reach the out-of-pocket spending limit, which will be $6,350 in
2020, they will enter the catastrophic phase of the Part D benefit to cover
high-priced drugs, according to CMS.
If a Medicare recipient has limited income and
resources, they can try to qualify for Medicare’s “Extra Help” program.
NEW MEDICARE CARDS
Among other changes, officials also urged
recipients to be sure they have new Medicare cards. The Centers for Medicare
& Medicaid Services has removed Social Security numbers from all new cards
to help prevent fraud.
Instead, the new cards have a number called a
Medicare Beneficiary Identifier. Medicare recipients can no longer use the old
card after Jan. 1, 2020, so anyone who hasn’t received a new one should contact
1-800-Medicare, said SHINE’s Chansler.
“Don’t throw the old cards out in the trash
because it has that Social Security number on it,” she said.
Like any aspect of choosing your coverage, “make
all Medicare choices after carefully considering what your health situation
is,” said Bruns. “Even if you’re healthy, the lowest cost plans may have the fewest
benefits. It’s a roll of the dice. If you’re dealing with a chronic condition
like diabetes, a heart condition or treatment for cancer, then cheap insurance
is the most expensive insurance you can buy.”
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