Now is the time for anyone on Medicare to consider whether changes need to be made in their coverage. The annual Open Enrollment period ends Dec. 7th, 2018. You may have seen commercials advertising how easy it is to change your plan. But wait, is it necessary? Have you moved? Has your health changed? Have your prescriptions changed? Has you financial situation changed? Have you run into problems with finding providers?
If you answered “yes” to any of the above questions you should probably investigate whether a change makes sense for 2019.
If you are eligible for Medicare and did not enroll in Medicare B or Part D, there may be penalties. You have 3 months before and 3 months after the month you turn 65 to enroll. After that you accrue penalties that will be with you for your lifetime on Medicare. If you’re in this boat, do not delay!
What is Medicare?
Medicare can seem like an alphabet soup: Parts A and B comprise “traditional” Medicare coverage. Part A is for in-patient care and Part B covers out-patient services. Part D is for prescription drugs. These building blocks of Medicare, however, have deductibles and do not provide 100% coverage. Most people opt to supplement traditional Medicare with a MediGap (Supplement) plan and a Part D prescription plan or choose a Medicare Advantage plan that packages all their Medicare benefits and includes prescription coverage. In all cases, the Part B premium ($135.50 in 2019) must be paid.
Medicare Advantage programs are available through private health insurance companies with networks of local providers; monthly premiums can range from $0 to $200. Then you “pay-as-you-go” – a copay or percentage coinsurance each time you access a medical service. Advantage plans cover everything that Medicare covers and additionally can offer extra benefits – limited dental, vision, hearing and even gym memberships. And drug coverage is included with the plan.
With Medigap (Supplement) plans you can choose different levels of coverage but, once you pay the monthly premium (in the $150-$200 range for 65 year olds and likely to increase with age), there are no copays or deductibles for any medically necessary services that traditional Medicare covers. It’s a “pre-paid” plan and the cost for your health care is known and predictable. Since it doesn’t include Rx coverage, most people choose to add a Part D plan. Usually there are no extra benefits such as those offered by Advantage plans. And, while Advantage plans have to accept any applicant; Medigap plans can – after a person’s first six months on Medicare – deny coverage for health reasons to new applicants. While any year you could switch from a MediGap to an Advantage plan, you might not be able to go the opposite direction.
Advantage plans have contracted networks of local providers. HMO plans limit coverage to their local network; PPO plans allow you to go outside the network for somewhat higher copays. MediGap (Supplement) plans are national rather than local and will cover any provider who accepts Medicare and may be a better choice for snowbirds or others who expect to spend time out of the area. All plans, however, will provide emergency coverage, often world-wide, but may require you to return to your local network providers to receive follow-up care. Usually separate travel insurance is recommended for international travel.
Lots to think about but it can make a big difference in your costs and health over the long run. Need help sorting out your options? SHIBA volunteers are trained to help. Call 541-812-0849 to schedule an appointment; there are some times still available next Monday, December 2.