By Debbie Gardner
debbieg@thereminder.com
It’s Medicare Open Enrollment Period now through Dec. 7, but this year enrollees are also facing some changes to plan offerings and benefits in addition to the traditional deadline to sign up.
To help Prime’s readers better understand how these changes might affect their coverage options, we reached out to Mike Festa, State Director of AARP Massachusetts, for some clarity on these changes and updates.
Here’s his explanation of some of these changes, and what they might mean to your coverage and out-of-pocket expenses in 2019:
Q: Medicare is offering a limited special enrollment period January 1 to March 31, 2019. How can Medicare recipients use this to their advantage?
“If someone misses their Initial Enrollment Period or Special Enrollment Period, they can sign up for Medicare during the General Enrollment Period between January 1 and March 31 each year. Coverage will then begin for them on July 1.
“However, enrollees signing up during this time period beginning in January may have to pay a higher premium for Part A and/or Part B.
“Individuals who sign up for a Medicare Advantage plan during Open Enrollment at the end of 2018 can use this January – March 2019 period to change Medicare Advantage plans or return to Original Medicare if they find, after a careful examination of the benefits offered, the plan they initially chose does not fully fit their needs.”
Q: The 2018 Chronic Care Act gave Medicare Advantage plans more flexibility in their coverage options. What should enrollees look for when considering these plans as opposed to Original Medicare?
“The Chronic Care Act allows Medicare Advantage plans some greater flexibility in designing benefits and cost-sharing, such as lowering copays for certain services, providing additional services, or using more telehealth to deliver care.
“Consumers should compare out-of-pocket costs of different plans, as well as compared to Original Medicare. People need to be aware, though, that Medicare Advantage plans have limited provider networks, while nearly all doctors accept Original Medicare. You should make sure the provider you want to see accepts the Medicare option you want to use.
Q: The “donut hole” in Part D prescription drug coverage is slated to go away a year early, in 2019 instead of 2020. What kind of effect will this change have on premiums and/or drug co-payments in the coming year?
“The donut hole has been narrowing each year since the Affordable Care Act (ACA) was passed in 2010. The gap was scheduled to close in 2020, when beneficiaries would be expected to pay 25 percent of the cost of all their prescriptions while they were in the gap. Under a new budget deal passed in February 2018, the donut hole will now close next year. Beginning in 2019, Part D enrollees will pay 25 percent of the cost of all their prescription drugs from the time they enter the gap until they reach catastrophic coverage.
“The changes made to Part D in the budget deal will also lower out-of-pocket costs for Part D enrollees who take brand-name drugs.
Starting in 2019, brand-name drug manufactur-ers will have to pick up more of the cost of their drugs when an enrollee is in the donut hole. This will help enrollees reach catastrophic coverage faster, where they pay 5 percent of their drug costs for the rest of the year. This change could also help to lower premiums.”
For more information on the upcoming changes to Medicare in 2019, you can do research at the following sites:
The government office on Medicare benefits at www.medicare.gov
AARP provides tools to help retirees and those close to retirement make smart choices about Medicare plans and coverage at www.aarp.org/health/medicare-qa-tool/
