Medicare Open Enrollment, which is also called the Annual Election Period, refers to the period from October 15, 2019, to December 7, 2019, when those who are enrolled in Medicare are able to change or keep their prescription drug and medical coverage plans. After this period, very few or no changes in your Medicare health coverage are allowed without special exceptions. If you are satisfied with your current plan, it is not necessary to make any changes. All new changes in coverage that you do select take place beginning on January 1, 2020. Read on to learn all you need to know about Medicare Open Enrollment.
Ask Questions and Get Informed About Your Medicare Coverage Options
During the Medicare Open Enrollment period, it is essential to ask informed questions to make sure you are making the best choices for your Medicare coverage.
Make sure you understand if any of your coverage options have changed, including the following:
- Do you still have the same insurance plans available to you as you had last year?
- What new options in healthcare plans and costs are available to you in 2020?
- When examining all the plan options available to you, what are the out of pocket costs to you, what are the deductibles, what hospitals and physicians are in-network?
- What are your top priorities? Is it keeping your current physicians? Reducing overall out of pocket costs or having access to a certain hospital? Having a zero monthly premium?
- What are your priorities for the next year? Do you need any elective surgeries? Do you need extensive dental care? Do you have special vision needs for next year, including new glasses or contact lenses? Do you need a Medicare Supplement Plan?
- Do you want medical services provided by an HMO or a PPO?
- Do you have expected lifestyle changes over the next year to consider, like anticipated changes in a career or reduction in income?
Understanding Your Medicare Coverage Choices – Original Medicare, Medigap, and Medicare Advantage Plans
Choosing Original Medicare
When choosing your doctors and hospitals, you can choose any doctors or hospitals who accept Medicare.
After you pay your yearly deductible, Medicare pays 80% of approved amounts for approved doctor’s services and durable medical equipment. You are then responsible for the remaining 20% of Medicare-approved costs.
Adding a Medigap Policy to Original Medicare
A Medigap policy, which is also called Medicare Supplement Insurance, covers what Medicare does not cover, including copayments, co-insurance, and deductibles.
In order to have a Medigap policy, you must already have Medicare parts A and B. A Medigap policy is purchased from a private insurance company and is paid for through monthly premium payments. Medigap policies must be purchased for each individual covered by Medicare and does not cover long term care, dental care, glasses, hearing aids, or private nursing care.
Choosing a Medicare Advantage Plan
A Medicare Advantage Plan (Part C) provides Medicare Parts A and B coverage through a private insurance company. It also usually provides prescription drug coverage (Part D). You can use Medicare’s Plan Finder to find and compare Medicare Advantage Plans in your area.
Types of Medicare Advantage Plans – HMO, PPO, Private Fee for Service Plans
There are several different types of Medicare Advantage Plans, including HMO, PPO, and Fee for Service Plans.
HMO Medicare Advantage Plans
If you choose an HMO Medicare Advantage Plan, you are required to choose in-network doctors and hospitals for your medical care. In most cases, the HMO will also offer prescription drug coverage.
You will need to choose a primary care doctor, and referrals are necessary in order to see a specialist.
If your doctor happens to leave the HMO network, you will have to select another primary care physician.
If you obtain any care outside of the network, you may have to pay for the full cost of treatment.
PPO Medicare Advantage Plans
If you choose a PPO Medicare Advantage Plan, you can see any physician of your choosing either in-network or out of network, but this type of plan usually has a high monthly premium.
Most PPO Medicare Advantage Plans also have a prescription drug coverage component.
As a PPO Medicare Advantage member, you are not required to choose a primary care physician.
How to Compare Medicare Advantage Plans in Your Area?
It is very important to consider the following when choosing a Medicare Advantage Plan:
- Does the plan have a 0 monthly premium or a monthly premium that you can afford?
- Does the plan provide for 0 copays for doctor’s visits and hospital stays, or are there significant out of pocket costs that are not affordable for your current financial situation?
- Does the plan have a 0 prescription copay or high copays, especially if you are taking multiple brand name medications?
- Does the plan provide an allowance for hearing aids and eye exams?
- Does the plan provide for free access to fitness programs?
Important Changes in Medicare Effective in 2020 to Consider When Selecting Your Medicare Plan During Open Enrollment
There are a number of important changes to Medicare that will take effect in 2020 and which should be considered when deciding what Medicare plan should be selected by you during the open enrollment period.
The Medicare Monthly Premium Will be Increasing in 2020
When enrolled in Medicare part B, there is a monthly premium that must be paid by everyone to continue in the program. The amount of this premium is usually deducted from the monthly Social Security payment. In 2019, this monthly Medicare premium was $135.50. In 2020 the monthly Medicare premium will increase to $144.60 per month. This is an increase in the monthly premium of $9.10. If you are receiving Social Security, the cost of living increase for 2020 will be 1.6% or approximately $24 on the average per month. This means that with the $9.10 monthly premium increase, the actual cost of living increase will only be $14.90.
The Medicare Part B Annual Deductible Will be Increasing by $13 in 2020
The Medicare Annual Deductible is the amount that you must pay first out of pocket before Medicare will pay for medical care or prescriptions. If you select regular Medicare for your coverage, you are generally responsible for paying 20% of the Medicare-approved amounts for physician services, outpatient therapy, and durable medical equipment after paying your yearly deductible. The Medicare Part B Annual Deductible in 2019 was $185.00. This amount is scheduled to increase to $198.00 in 2020.
Medicare Part A premiums, Co-Insurance, and Deductibles will all increase in 2020
Medicare Part A covers inpatient hospitalizations and skilled nursing care. Patient deductibles, premiums, and copayments for Medicare Part A are all expected to increase in 2020.
Medigap Plans C and F Will No Longer be Available to New Medicare Beneficiaries
If you are a Medicare beneficiary who is newly eligible for Medicare benefits, Medigap Plans C and F will no longer be available to you.
The Medicare Plan Finder Tool is Being Updated for the First Time in 10 Years in 2020
The Medicare Plan Finder Tool has been upgraded to assist Medicare recipients in finding affordable Part D Drug Plans, Medigap policies, and Medicare Advantage Plans.
Starting in 2020 Income Brackets Will Be Adjusted for Inflation
Those Medicare beneficiaries who are in higher income brackets are required to pay more for Medicare Part B and D than do those in lower-income brackets. Previously, in 2019, high-income Part B enrollees were considered to be those earning $85,000 per year for a single person and $170,000 per year for a married couple. The Medicare premiums for those higher-income individuals in 2019 ranged from $189.60 per month to $460.50 per month. Beginning in 2020, the threshold to be considered in the higher income brackets and subject to a Medicare premium surcharge is $87,000 a year for individuals and $174,000 for a married couple. In 2020 the Medicare premiums adjusted for inflation for higher-income individuals will be from $202 per month to $460.50 per month.
The Open Enrollment period from October 15 to December 7, 2019, is the time when you can make important changes to your Medicare coverage if your financial or personal situation has significantly changed. By carefully considering the types of plans available in your area, you will be able to determine if traditional Medicare, traditional Medicare with a Medigap policy or a Medicare Advantage plan best fits your needs. Using the newly upgraded Medicare Plan Finder Tool can help you to compare plans with higher monthly premiums and extended coverages but lower copays and deductibles with other plans that can have zero monthly premiums but higher copays and other out of pocket expenses for outpatient procedures and X-ray and laboratory expenses.