Medicare Open Enrollment 2019
Medicare has strict rules about when eligible consumers can enroll in health care coverage. Every fall, millions of Americans who are over the age of 65, are on disability, or have end-stage renal disease (ESRD) can use the Open Enrollment Period to add, subtract, or change Medicare coverage for the following year.
Unlike the Initial Enrollment Period, which lasts up to seven months, however, the Medicare Open Enrollment period lasts just eight weeks. Maximize that time by knowing your options ahead of time.
If you’re happy with your current Medicare coverage, do you need to re-enroll in the same plan? Nope. Your coverage will roll over without you doing anything. On the other hand, if you want to change coverage, save money, or just see if there’s a better option out there, here’s what you need to know this fall.
Medicare Open Enrollment 2019
The Medicare program typically releases an extensive list of changes for the following year in April, but this document is often hundreds of pages long. To help get you ready for Open Enrollment, here are the highlights for 2019:
The federal government has eased several regulations to allow physicians and Medicare Advantage companies to more quickly and effectively communicate with both Medicare and Medicare recipients. As a result, you could see the following:
- Documents emailed to you instead of being physically mailed.
- Face time with doctors who spend less time on paperwork.
- Easier-to-understand Medicare Advantage plan descriptions.
Medicare Advantage (MA) Open Enrollment Period
This new enrollment period from January 1st through March 31st each year will replace the Medicare Advantage Disenrollment Period (January 1st through February 14th). During this new enrollment period, people already enrolled in an MA plan can do these things:
- Switch MA plans
- Switch from MA back to Original Medicare, then add prescription drug coverage (Part D)
Prescription drug coverage
In response to the national opioid crisis, Part D plans can now restrict access to opioid drugs for certain patients.
You may also see a drop in costs due to some changes to cost-sharing rules, more flexibility with substituting generics for brand-name drugs, and waste reduction in long-term care settings.
Medicare cost updates
2019’s Part A annual deductible is expected to increase from $1,340 to $1,364, while daily deductibles for hospitals stays will be slightly lower at $329 (down from $335 in 2018). Part B’s standard premium for people who make $85,000 or less will rise $1.50 to $135.50. The annual deductible will be $185 (up from $183 in 2018).
Part D deductibles will increase by $10 to $415. The Initial Coverage Limit will jump $70 to $3,820, and the Out-of-Pocket Threshold will be $100 higher at $5,100. Catastrophic Coverage copayments will rise a few cents to $3.40 for Generic/Preferred Multi-Source drugs and $8.50 for Brand/Other drugs.
While the Coverage Gap was scheduled to close in 2020, it will disappear a year early. That means beneficiaries of Part D plans will pay a maximum of 25% of their prescription drug costs.
Still have questions about changes to Medicare in 2019? Get more details about what’s new in Medicare 2019, or talk to an experienced Medicare agent.
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What is Open Enrollment?
Medicare has several enrollment periods, and each applies to people in different situations. Missing the right period could mean a gap in coverage, late enrollment penalties, or getting stuck in the wrong plan for another year.
So who is Open Enrollment for, and what exactly can you do during this period?
Medicare Open Enrollment, also called the Annual Enrollment Period (AEP), is from October 15 to December 7 every year. During this eight-week period, those who already have Medicare can change plans and add or subtract coverage.
Open Enrollment is the time to do any of the following:
- Switch from Original Medicare (Parts A and B) to Medicare Advantage (Part C)
- Add, change, or drop Medicare prescription drug coverage
- Switch from Medicare Advantage to Original Medicare
- Switch from one Medicare Advantage plan to another Medicare Advantage plan
The Open Enrollment Period from October 15, 2018 to December 7, 2018, is called “Medicare Open Enrollment 2019” because any changes you make to your coverage during that time will begin January 1, 2019.
What Open Enrollment isn’t
If you’ve ever had health insurance through an employer, waiting for your annual open enrollment period each fall to renew your coverage probably seems old hat. Things work a bit differently with Medicare’s Open Enrollment, however.
In a nutshell, Open Enrollment is not for people enrolling in Medicare for the first time, for those who have missed their Initial Enrollment Period, or for those who suddenly lose coverage from another source.
What about Medigap?
Medigap (Medicare Supplement) is additional, optional insurance offered by private companies to help Medicare beneficiaries pay for some health care costs that Original Medicare doesn’t cover. The best time to get a Medigap plan is during Medigap Open Enrollment, which is a six-month period that begins just after you enroll in Original Medicare for the first time.
During Medigap Open Enrollment, which is not the same as Medicare’s annual fall Open Enrollment Period, you cannot be denied a Medigap policy because of pre-existing conditions. If you wait to enroll in or change your Medicare supplement policy until the annual fall Open Enrollment Period, you could be denied Medigap coverage or have to go through a rigorous underwriting process.
When to sign up for Medicare
How and when you should sign up for Medicare depends on your situation. People newly eligible for Medicare may be enrolled automatically. If you don’t get your Medicare card in the mail a few months before your 65th birthday, you may need to sign up for Medicare yourself through the Social Security Administration.
Medicare has several different enrollment periods aimed at people in different situations.
Medicare’s Initial Enrollment Period is a seven-month period when newly eligible consumers can sign up for Medicare for the first time. It typically begins three months before the month of your 65th birthday and ends three months after. Anyone who is eligible for Medicare for the very first time should not wait for Open Enrollment. Doing so could invite Late Enrollment Penalties.
If you suddenly lose health insurance coverage from your employer or your current Medicare plan, don’t wait for Open Enrollment to find new coverage. In many situations, you can get a Special Enrollment Period to avoid a gap in coverage.
Open Enrollment also isn’t for people who have missed their Initial Enrollment or Special Enrollment Periods altogether. These people will have to wait until General Enrollment (January 1 through March 31).
If you’re not sure when or how to enroll in Medicare, then give us a call.
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Changing Medicare plans during Open Enrollment 2019
Are you happy with your Medicare coverage? If not, Open Enrollment is the perfect time to change that by switching plans. If you do like your coverage, Open Enrollment is a great time to review any changes made to your current plan and see if there’s an even better option out there.
People who expect their coverage needs to change (due to new prescriptions they’ve started taking or diagnosis of a long-term health condition, for example) should consider adding coverage, while those who haven’t used many of their benefits may want to downsize to a cheaper plan.
Since many Medicare health plans change annually (some may even change throughout the year), taking the time to see what’s new can save you some considerable cash.
Annual Notice of Change
Before creating a game plan for maximizing your Open Enrollment Period, understand how your current plan may change moving forward. Annually, Medicare policies can change costs, coverage,in-network providers, pharmacies, and more.
Medicare requires your current plan to send you an Annual Notice of Change (ANOC) by September 30 outlining all changes that will go into effect January 1 of the following year. If you receive one of these documents, look it over carefully as soon as possible. Doing so will help guide you during Open Enrollment starting October 15.
Changing plans: Original Medicare to Medicare Advantage
People who switch from Original Medicare (also called traditional Medicare) to Medicare Advantage typically do so because they want one of these things.
One comprehensive plan
Because Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) cover different things, knowing when you’re covered can be challenging. Since Medicare Advantage Plans combine Parts A and B in a single plan, keeping track can be more straightforward. Many Medicare Advantage plans include Part D prescription drug coverage as well.
More coverage options
Original Medicare coverage is uniform hospital and medical insurance coverage, and benefits are the same for everyone who enrolls. If you need more personalized coverage, then it may be time to switch.
More coverage, period
Original Medicare is the minimum standard for all Medicare Advantage plans. That means all MA plans must cover at least everything Parts A and B cover, but they can (and most do) offer better coverage, such as a lower (or no) deductible and lower copayments or coinsurance. Many Medicare Advantage plans also cover prescription drugs, sometimes with better coverage for brand-name drugs. Additional care covered by some plans may include dental, vision, hearing, and long-term care.
If all that sounds pretty good, peek at the next section on going the other way (switching from Medicare Advantage to Original Medicare) to see what you might be giving up. Then, use our Suggest-a-Plan tool to find Medicare Advantage plans or give us a call, and we’ll help you find the right policy.
Changing plans: Medicare Advantage to Original Medicare
Medicare Advantage plans are a great one-stop shop for health care coverage, but they may come with additional costs, both financial and otherwise. Some people use their Open Enrollment Period to switch back to Original Medicare for these reasons.
If you expect to have a lower income or fewer medical needs next year, it may make sense to switch plans since Parts A and B combined typically have lower premiums than Medicare Advantage plans do. Calculate costs carefully, however, because Original Medicare usually also offers less coverage, and you may have higher out-of-pocket expenses.
You may also need to enroll in Part D prescription drug coverage, which will require an additional monthly premium. Skipping prescription drug coverage could result in a Late Enrollment Penalty added to Part D premiums in the future if you later decide that you do want this coverage.
More freedom to see more doctors
Most Medicare Advantage plans are HMOs or PPOs, which prefer or even require that you get care within their network of preferred providers. Since each insurance company negotiates with medical providers individually, that network may be quite small or localized. Original Medicare, however, covers visits to any provider who accepts Medicare, so you may have more options by switching to Parts A and B.
A stable plan with few changes year over year
Because private insurance companies offer and manage Medicare Advantage plans, they can choose to change, add, and eliminate plans each year. Some plans may remove your service area from their coverage throughout the year, requiring you to change plans during a Special Enrollment Period. Original Medicare, on the other hand, generally makes only small, incremental changes to plans each year.
Ability to pick and choose coverage
Medicare Advantage plans are great for people who want more comprehensive coverage all in one place, but this may be a drawback for people who can get some health care insurance from an outside source, such as a current or former employer or a retirement benefit. Many of these plans offer coverage that’s better than Original Medicare for low or no monthly premiums.
While beneficiaries can use some of these private plans in conjunction with Medicare, they would likely result in duplicate coverage—and paying double premiums—if paired with Medicare Advantage. Switching to Original Medicare could save people in this situation from unnecessarily spending more on a Medicare Advantage plan.
Changing plans: switching Medicare Advantage plans
There are thousands1 of Medicare Advantage plans out there, and they vary widely by both cost and coverage. Consumers who have an MA plan and want to continue in that vein can shop around for new Medicare Advantage plans during Open Enrollment for several reasons.
Your current plan has changed or stopped
Because private companies run individual Medicare Advantage plans, these plans tend to change more frequently than Original Medicare. They may even make some changes throughout the year, such as covering different prescription drugs or altering their service area. If you’re not happy with these changes, use Open Enrollment to find a better option.
Your situation has changed
Just as many MA plans don’t stand still for long, your life doesn’t either. Changes in lifestyle, health, and medications could mean your current plan isn’t your best option anymore. Open Enrollment gives you the chance to find a plan that’s better suited to the new you.
You want a better deal
Some consumers who are completely happy with their current MA plan make it a habit to shop around for better plans each year anyway, ensuring they always get great coverage for the best price.
Changing plans: prescription drug coverage
Most Medicare Advantage plans include prescription drug coverage, but Original Medicare doesn’t. Many consumers have a privately run Medicare Part D plan, but this form of drug coverage is incompatible with most Medicare Advantage plans. You may want to change, add, or drop a Part D plan during Open Enrollment if one of the following applies.
You switch between Original Medicare and Medicare Advantage
Since Part D plans provide the prescription drug coverage that Original Medicare plans lack, you may want to add a Part D plan to your coverage if you’re switching from a Medicare Advantage plan. If you’re changing in the opposite direction, from Parts A and B to Medicare Advantage, you may need to drop your current Part D plan.
Keep in mind that going without approved prescription drug coverage for any length of time may result in Late Enrollment Penalties added to your monthly Part D premiums in the future.
Your current prescription drug plan changes
Part D plans can change coverage both annually and throughout the year. Plans must give you ample notice (either in the form of an Annual Notice of Change or notifications when altering coverage for a drug you’re already taking). If you get one of these notices, it may be time to shop around for a plan that still offers the coverage you need.
You want a better deal
Like Medicare Advantage enrollees, many Part D enrollees use the annual Open Enrollment period to see what else might be out there. Who knows? Since companies regularly offer new Part D plans, you could find a better deal even if you’re happy with your current plan.
What to look for when comparing plans
Considering switching plans, but aren’t sure where to start? You’re not alone. Many people feel overwhelmed by the staggering number of options and requirements for Medicare. But don’t worry. We have your back.
Start by using our Suggest-a-Plan tool to create a shortlist of plans that meet your basic criteria. Then, use the following factors to narrow down your choices. That, or give us a call, and we’ll recommend the best plans for your health care goals and make enrollment super easy.
Not all plans are available everywhere. Make sure the plans you’re sorting through cover your service area before you go too far down the rabbit hole.
In-network healthcare providers
Some MA plans may require that you see doctors in the plan’s network to be covered for treatment. If the nearest in-network doctors are across town, you’ll face the decision to travel long distances to get the care you need or shell out the extra cash to go out of network. Not surprisingly, that’s a deal-breaker for lots of people.
Plan quality ratings
Next, get the federal government’s opinion by checking out a plan’s rating, which is based on how the plan performs for helping you stay healthy, manage chronic pain, get customer service help, and more.
Four- and five-star ratings mean the plan is probably doing something right, while one- and two-star ratings mean the plan is perhaps missing the mark. You can compare quality ratings for Medicare Advantage and prescription drug plans here.
Many people factor premiums into their decision but don’t pay enough attention to other figures. Plans with low premiums often come with substantial out-of-pocket costs in the form of high deductibles, larger copayments, or lower coverage.
If you don’t expect to use your insurance much, a small premium could be the way to go. But if you see the doctor a lot, buy a lot of prescriptions, or have a severe medical condition, paying a higher premium for a better plan might save you money down the line. Learn more about Medicare premiums and deductibles.
Look at each plan’s covered services to make sure it includes the ones you may need. If you’re shopping for Medicare prescription drug coverage, take a look at each plan’s list of covered drugs to see if it includes your medication and how much the copayment or coinsurance is for each. Look for any additional coverage rules, such as prior authorization or step therapy.
For many, retiring will bring more opportunities to travel, both locally and internationally. If that’s you, pay close attention to whether your plan will cover you when you visit family out-of-state or take that trip to Paris you’ve always dreamed of.
Medicare Open Enrollment 2019: are you ready?
Keeping up with changes to Medicare and requirements for switching plans can seem daunting, but you’re not alone. Millions of Americans will be making similar choices this fall.
Besides, here at MedicareHealthPlans, we’re here to help. Check out our Suggest-a-Plan tool to narrow your choices, or just give us a call and one of our licensed agents will walk you through the entire process.
Or, just give us a call at 855-802-1206.