For Medical plans with coverage beginning on January 1, 2019, …
the Medicare open enrollment period is between October 15, 2018 through December 7, 2018.
The period of open re-enrollment is the time for Medicare recipients to take a close look at their existing plan and investigate alternative choices to end up with the best possible coverage for their needs.I licensed and qualified Medicare Insurance Agent may be an asset in educating you on the various options as well as helping you understand Medicare and the various aspects.
Any coverage adjustments chosen during open enrollment will commence on January 1 of 2019.
Open enrollment in the Medicare context is distinct from that for the marketplaces instituted under the Affordable Care Act, also referred to as the “exchanges.” Open enrollment for those coverage plans tends to begin on November 1 of each year, though state programs can vary.
There are significant numbers of senior citizens who have the erroneous belief that they have the ability to enroll in Medicare plans through an ACA marketplace. Though it is true that the ACA exchanges do sell private insurance plans to Americans under the age of 65, Medicare plans are not sold in this way. Citizens covered by Medicare need not enroll via the ACA marketplaces.
Let us turn to open enrollment processes for Medicare recipients and review several key pieces of information.
Open Enrollment Choices For Medicare Recipients
When the open enrollment period begins, if you are covered by Medicare you will able to:
* Take no action and retain your present drug and medical coverage plans
* Change from an original Medicare plan in favor of a Medicare Advantage option
* Change from Medicare Advantage to original Medicare
* Switch to a different Medicare Advantage plan
* Switch to a different Part D drug coverage plan, enroll in one for the first time or drop existing drug coverage
The Centers for Medicare and Medicaid Services have revealed that 73 percent of all Medicare Advantage plans boast a quality rating of at least four out of five possible stars as of 2019. This is an improvement of the 69 percent statistic of 2018.
If Your 65th Birthday Is Approaching
You are given three months prior to the month in which you turn 65 and three months after that month to complete your Medicare enrollment. If you will be turning 65 this autumn, it will be necessary to enroll so that you are covered through the remaining part of this year and also sign up for 2019 coverage.
If your coverage prior to turning 65 was obtained through an ACA exchange, an individual insurance policy or through your place of employment, you may keep that coverage until the Medicare coverage you select is scheduled to begin. After Medicare takes effect, you are free to cancel the private insurance or marketplace policy and face no financial penalty for having done so. Should you continue working and receiving health insurance from an employer, it may be possible to hold off on Medicare Part B enrollment until you stop working, and do so without penalty.
Medicare Part A is designed to pay for inpatient medical care, and it is usually provided without premiums. Therefore, it may be wise to secure Part A coverage while also maintaining your existing coverage for office visits and outpatient care. In such a situation, it makes good sense to talk to your employer’s human resource and benefits personnel to make sure all bases are covered.
Conduct An Annual Medicare Coverage Review
It is quite possible that your life will undergo certain kinds of transitions that necessitate adjustment to your plans. As an example, your physician could prescribe a number of different medications to treat a condition, or you might experience a medical crisis of some sort. In addition, insurance carriers regularly make changes and additions to the Medicare Advantage plans they offer. As such, it is always wise to take a close look at your coverage each year to verify that your needs are being adequately met.
Prior to the open enrollment period each year, you should be receiving an “Annual Notice of Change” from your carrier. The information contained in this document needs to be closely scrutinized so that you understand adjustments to coverage and costs for the upcoming year. Some of the critical questions you should be asking include:
* Will the prescription drug coverage pay for the specific medications you require? What coverage rules exist as related to medications? Is it possible to obtain medication through pharmacies and via mail-order services?
* Are the physicians and hospitals you prefer within the plan’s network? Are referrals required for visits to specialists?
* What will you be required to pay in terms of out-of-pocket expenses and regular premiums, deductibles, co-pays and the like?
* What quality rating does your plan have?
* Does your coverage extend to times when you are in a different state or country?
* If you are eligible for other types of coverage, such as that provided by an employer, will Medicare work effectively in conjunction with it?
Two Primary Methods For Purchasing A Medicare Plan
Obtaining Original Medicare Coverage
Original Medicare is a program run by the federal government, and it encompasses Parts A and B. Hospital care is covered by Part A, while Part B is designed to cover things such as lab testing, preventive health services, outpatient care, office visits and the like.
If you and/or your spouse worked and paid Medicare-designated taxes, you probably will not be required to pay a Part A premium. A deductible, however, will be required, prior to the start of coverage for hospital care. Part B requires a monthly premium in addition to coinsurance and deductible payments. Original Medicare allows recipients to use any physician or hospital they like, provided that they accept patients with Medicare.
It is also possible to add drug coverage in the form of a Part D plan. These plans are offered by private insurance carriers, and the coverage receives the approval of Medicare. A monthly premium will be required for a Part D plan. There is no availability of Part D plans within Medicare Advantage, but it is common for those kinds of plans to include prescription drug coverage of their own.
Seniors have the option of purchasing a Medigap supplemental coverage plan as a means to pay for some of the out-of-pocket expenses that would otherwise need to be met. Medigap plans are obtainable through numerous private insurance carriers, and they are designated by letters A through N in the majority of jurisdictions.
The yearly open enrollment period for Medicare does not afford a guaranteed right when it comes to switching Medigap plans. Rather, it is better to purchase Medigap plans in the first half of the year that you are 65 years of age or older and currently have Medicare Plan B coverage.
This is the period in which the federal government provides a right to purchase a plan, no matter your current health status. Medigap plans may be bought or changed later on, but with very few exceptions, Medigap plan providers are free to decline your request for coverage or charge increased premiums due to health concerns. While the Affordable Care Act did prohibit insurance companies from declining coverage or raising prices for those with existing conditions, the provision does not extend to Medigap scenarios, because the insured parties are older than 65. It must be borne in mind that Medigap plans really are not insurance, but rather assist with the payment of healthcare expenses.
Purchasing A Medicare Advantage Plan
Insurance carriers that have received Medicare approval are free to sell plans referred to as Medicare Advantage coverage. Plans in this category tend to work similarly to HMOs (health maintenance organizations) or PPOs (preferred provider organizations).
For these plans, participants are required to use only those hospitals and doctors that are within the network, or else they will face greater out-of-pocket costs. A Medicare Advantage plan is an optional component of Original Medicare’s Parts A and B, and they generally do cover the cost of prescription medications. There are also plans designed to cover dental and vision care. Participants pay monthy premiums, coinsurance and co-pays.
Beginning in 2019, the government is allowing Medicare Advantage plans to offer additional types of benefits that may serve to bolster the health of insured parties, including the provision of transportation to and from physician visits.
It should be noted that anyone with a Medicare Advantage plan is ineligible to purchase a Medigap plan.
Pricing Of Medicare Plans
Since the advent of the Affordable Care Act in 2010, the cost of premiums for Medicare Advantage plans has dropped. For the year 2019, it is anticipated that the average cost per month of a Medicare Advantage premium should decline to about $28, a reduction of 6 percent. According to CMS, roughly 83 percent of enrollees in Medicare Advantage plans will be paying equal or lower premium amounts if they opt to remain in their current plan. Approximately half of all those enrolled in Medicare Advantage plans will pay no premiums whatsoever during 2019.
In addition, enrollees in Medicare Advantage will experience a broader range of choice during 2019. CMS reports that available plan options are likely to rise from roughly 3,100 to nearly 3,700. About 90 percent of Medicare participants will be able to choose from no less than 10 Advantage plan varieties. This represents an increase from the 86 percent who could do the same in 2018.
Analysts predict that enrollment in Medicare Advantage plans will keep increasing in 2019. It is anticipated that enrollees will rise in number from about 20.2 million to roughly 22.6 million. This is a boost of 11.5 percent, or approximately 36 percent of the entire ranks of Medicare recipients.
What Are The Costs For The Different Kinds Of Medicare?
Part A: The majority of Part A participants pay no premiums whatsoever. But, if you do not meet the criteria for no-cost Part A coverage, you will need to pay a premium of $422. Each benefit period comes with a $1,340 deductible. Benefit periods start from the day of inpatient admission to either a hospital or a skilled nursing facility. Benefit periods end once you have not been receiving inpatient care for 60 consecutive days. An average Part A deductible stands at $1,364.
Part B: A typical premium for Part B coverage stands at $135.50, though it is generally a touch lower. But, if your income is on the higher side, you may have to pay greater costs that do not exceed $428.60 each month. This applies to those receiving over $160,000 annually as a single person or $320,000 as a married couple. Deductibles are $185 per year, and once that deductible is met, payment of 20 percent of Part B costs will be required.
Part C: Average monthly premiums for Medicare Advantage will run about $28 during 2019. This is a decrease from 2018’s average of $29.81. Roughly 46 percent of enrollees will not pay any premiums at all, but it is important to keep in mind that you will get that for which you pay. Therefore, it is wise to ensure that your chosen Medicare Advantage coverage really does what you need it to and is not simply the least expensive.
Part D Drug Plans: The majority of Medicare plans for drug coverage require a monthly payment based on the plan itself. Average basic premiums for 2019 will be $32.50, a decline from 2018’s figure of $33.59. CMS has facilitated improvements to available Plan D offerings, including expanded freedom to purchase generic medications, something which is certain to keep costs down. Required deductibles do vary, but Medicare D plans are not permitted to have deductibles greater than $415 during 2019.
The often-cited “donut hole” is the gap in coverage that can occur when there is a need for massive drug expenditures. This is when insured parties will have to pay a substantial part of their medication expenses. For 2019, the coverage limit that first sets in is set at $3,820. The “donut hole” gap for the year sits between $3,820 and $5,100.
Once $5,100 has been spent out-of-pocket by a beneficiary, catastrophic drug coverage will take hold so that only a relatively small co-pay or coinsurance amount will be required. This amount is set at 5 percent of the overall drug costs for the remainder of the coverage year. Coverage gaps of this sort are slated to end in 2020.
A Part D insured party will receive a “donut hole” discount of 75 percent for brand-name medications bought when he or she is within the gap amount. There is also a 37 drug discount for generics bought during the donut hole period.
How To Find Help
The Medicare.gov website is a treasure trove of information regarding the plan options in your specific area. Here you can find and download the “Medicare & You” publication. You may also call 1-800-MEDICARE for additional assistance. The Health Insurance Assistance Program in each and every state can also be extremely useful to those needing to learn more.