The annual Medicare open enrollment period opens tomorrow October 15th and closes December 7th and there are changes and improvements. Each year people should review their Medicare plan with an eye on plan changes, benefits and premiums. But this year is particularly important as the changes for 2019 could be significant to you or your loved-one.
Everyone on Medicare needs to do their homework. By now, those who have Medicare Advantage plans should have received two documents: the Annual Notice of Change (ANOC) and the Evidence of Coverage (EOC) as they were required to be mailed by September 30th. The EOC provides specific details about when the plan will cover costs, which will be needed if an appeal is filed. The ANOC lists the changes for the plan from 2018 to 2019. These documents are very important as they tell the subscriber information such as whether current prescriptions are in a different tier (at a different price), new restrictions including prior authorization, if pharmacies changed. You may also need to contact your plan for specific information.
It’s a very complex subject. Below is an overview of the Medicare plans and its components, and questions that should be asked. Once the questions are answered, plans can be evaluated that best one’s needs. It is very important to spend time comparing plans.
Medicare Plans and Components:
Part A covers hospital care, skilled nursing, hospice and some home health care. If the individual or their spouse has at least 10 years of Social Security work history, this part is free. If not, it can be more than $410 per month. The premium is determined by how many Social Security work credits a person has.
Part B covers doctor visits, preventive care, outpatient care and hospitals and some home health care. Part B will continue to cost from $134 to $429 per month depending on your income bracket.
Part C is also known as a Medicare Advantage plan. It substitutes for parts A and B and, in most cases, Part D, the drug plan. There is a small difference in 2018 premiums. Premiums vary by location and coverage.
Part D covers prescription drugs. Premiums are going down slightly.
The first big decision Medicare beneficiaries must make is whether to go with traditional Medicare (parts A, B and D) or a Medicare Advantage plan (Part C). Medicare Advantage plans have lower premiums, but they usually require members to get their care only from network doctors and hospitals. Both options have deductibles, copays and co-insurance, where the individual/spouse pays a percentage of the bill.
According to the U. S. government, the most pressing questions that need to be addressed are:
Coverage: How well does the plan cover the services you need?
Your other coverage: If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare.
Costs: How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.
Doctor and hospital choice: Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network? Do you need to get referrals?
Prescription drugs: Do you need to join a Medicare Prescription Drug Plan? Do you already have creditable prescription drug coverage? Will you pay a penalty if you join a drug plan later? What’s the plan’s overall star rating? What will your prescription drugs cost under each plan? Are your drugs covered under the plan’s formulary? Are there any coverage rules that apply to your prescriptions?
Quality of care: Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services?
Convenience: Where are the doctor’s offices? What are their hours? Which pharmacies can you use? Can you get your prescriptions by mail? Do the doctors use electronic health records (EHRs) or E-prescribe? Can you get an electronic copy of your information by email or to store in a personal health record? Which pharmacies can you use? Is the pharmacy you use in the plan’s network? If it’s in the network and your plan offers preferred cost sharing, does your pharmacy offer preferred cost sharing? You may pay less for some drugs at pharmacies that offer preferred cost sharing. Can you get your prescriptions by mail?
Travel: Will the plan cover you if you travel to another state or outside the U.S.?
If you need help evaluating plans, the Resource Directory on our website provides professionals who can help. Go to https://theseniorsanswer.com/resources/.
