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Medicare Open Enrollment Has Started

Beneficiaries have until Dec. 7 to review coverage, make changes

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En español | Beginning Tuesday, Oct. 15, Medicare enrollees have 54 days — until Dec. 7 — to review their medical and prescription drug coverage and make sure the plans they subscribe to best meet their needs.

The decisions you make during this open-enrollment period will take effect in January 2020. After reviewing your options, if you decide to stay with your current coverage you don't have to do anything. But remember: With a few exceptions, this is your one chance during the year to make changes.

"Taking the time to figure out which plans are likely to cost more or less can literally save thousands of dollars,” says Tricia Neuman, senior vice president of health policy and director of Medicare policy at the nonpartisan Kaiser Family Foundation. “People are skeptical that changing plans could make a difference so they're inclined to keep the same plans for year to year.” But Neuman urges enrollees to make time to check.

If you want to get going right out of the gate this year, you may want to wait to make final decisions. While the Centers for Medicare and Medicaid Services (CMS) has announced that the premiums for Medicare Advantage (MA) and Part D prescription drug plans are expected to decrease for 2020, the agency has not yet released the premiums and deductible amounts for Part A, which covers hospital stays, and Part B, which pays for doctor visits and other outpatient services.

The average MA monthly premium is expected to be $23 in 2020 and the average Part D drug premium is estimated to be $30. But these are only averages. MA and Part D premiums vary widely, depending on what plan you pick and where you live.

Experts caution that figuring out what makes the best sense financially for your needs is more complicated than just looking at premium costs.

"People tend to focus on premiums when they compare plans, but premiums are not a good proxy for the ultimate out-of-pocket costs consumers will pay,” says Neuman. When reviewing plans, she advises enrollees to be sure to double-check that the medicines they take are covered — either by the standalone Part D plan they're considering or an MA plan.

The type of coverage doctors and other health care providers accept also can change from year to year. If you are in Original Medicare, make sure that your doctor is still a participating Medicare provider. If not, you may be liable for higher out-of-pocket costs. If you belong to an MA plan, make sure your providers are still in the plan's network because if you see out-of-network physicians you'll usually have to pay more.

New for 2020

CMS has redesigned the Medicare Plan Finder website. The redesign has larger type, more white space, requires fewer clicks between pages and will allow you to compare prescription drug plans side by side, including information about preferred pharmacies and what they cost compared, for example, with ordering a drug by mail.

Also in 2020, Medicare Advantage plans will be able to offer an expanded set of supplemental benefits. People with chronic conditions, such as diabetes, will be eligible for nutrition counseling. Heart disease patients could get access to healthier produce or other food. Asthma sufferers could get home-cleaning services that could forestall attacks. The new services also include more in-home meals, transportation to medical appointments and improvements to a patient's home, including such things as wheelchair ramps and shower grips.

Be aware that not all MA plans will offer any or all of these supplemental services. CMS officials say enrollees can check out which plans have these extra benefits on the new Plan Finder site.

Beneficiaries who take many medications, especially expensive ones, could be in for some out-of-pocket sticker shock in 2020. After satisfying any deductible that their plan has (a maximum one of $415 in 2019 and $435 in 2020), beneficiaries are responsible for 25 percent of the cost of their drugs until they reach an out-of-pocket spending threshold and enter catastrophic coverage, where they have to pay just 5 percent of drug costs for the rest of the year. This year that threshold is $5,100, but in 2020, it will increase to $6,350. Based on how the benefit works, this means that people who take only brand-name drugs could have to pay about $400 more out of pocket before they qualify for catastrophic coverage.

Getting help

There are a variety of ways you can get personalized help as you wend your way through the open-enrollment process. You can use the Medicare.gov online chat feature throughout open enrollment. The Medicare hotline, 800-MEDICARE (800-633-4227), is open 24 hours a day, seven days a week. You may also call your local State Health Insurance and Assistance Program (SHIP) to speak with a Medicare counselor.

 

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