A TGB READER STORY: Every Tuesday
The Alex and Ronni Show: On the End of Life

Medicare Enrollment Period for 2019: Important Information

Okay, enough for now of this dying stuff of the past few days. Let's get on with the particulars of living – in today's case, Medicare.

On Monday this week, the annual Medicare open enrollment period began. It runs until 7 December which isn't very long if, like me, you procrastinate over such tedious work. But it's important so pay attention. I'll make this a easy and clear as possible.

Let's start with this (deceptively) simple overview of the process:

Here are the things you can do during this fall enrollment period:

If you now have traditional Medicare (Part A for hospital coverage; Part B for outpatient coverage), you can switch to an Advantage plan (Part C) if you wish

If you now have an Advantage plan, you can switch to traditional Medicare

If you dislike your current Advantage plan, you can switch to a different Advantage plan

If you have a Part D prescription drug plan, you can choose another or you can purchase one if you did not do so when you were first eligible

BACKGROUND INFORMATION
Remember, traditional Medicare (Parts A and B) is offered by the federal government. Advantage plans and Part D (prescription drug coverage) are commercial products although they must meet certain requirements of the government.

Here are the 2019 premium and deductible changes for traditional Medicare :

Ninety-nine percent of traditional Medicare beneficiaries pay no Part A (hospital) premium. The deductible, when you are admitted to a hospital, will be $1,364 for 2019, up from $1,340 this year.

The new Part B (outpatient) premium, deducted from your Social Security benefit each month, will be $135.50 in 2019, up from $134 this year. The deductible will increase to $185 from 2018's $183.

There is more detailed information on Part A and Part B premiums and deductibles here.

The grandmother of all Medicare information sources during fall enrollment is the Medicare and You 2019 book.

In the past, it was snail-mailed to every Medicare beneficiary in the U.S. Some people still get it that way. If you receive yours electronically or if you have misplaced it, you can download a copy online here. [pdf]

For Advantage plans (combined Parts A and B in one package with, most of the time, Part D), and for stand-alone Part D plans to go with traditional Medicare, there are differences from state to state. You can find information for each individual state here [pdf].

A NOTE ON SOME DIFFERENCES BETWEEN TRADITIONAL MEDICARE AND ADVANTAGE PLANS
Advantage plans sometimes have no monthly premiums and usually offer additional services such as coverage for vision, hearing and dental along with reduced gym membership fees and such which make them attractive.

However, each one also requires that you use their roster of physicians, hospitals and other service providers. Also, just this week, The New York Times reported on some Advantage plans that have been improperly denying claims.

Traditional Medicare leaves some gaps in coverage which beneficiaries fill in by purchasing supplemental (“Medigap”) and (Part D) policies but there are no plans with vision or dental or hearing coverage.

Generally, between the two Medicare possibilities, traditional Medicare delivers the widest choice of hospitals and doctors and with supplemental and prescription drug plans added in can result in much lower out-of-pocket costs particularly for people with serious health conditions.

That certainly is true for me over the past 16 months of heavy use and I'm now quite grateful I stayed with traditional Medicare. But needs, obviously, differ from person to person.

CHOOSING YOUR 2019 PLAN
Year after year, Medicare has been improving their Plan Finder pages - there can be more than two dozen plans depending on the state. You will find the beginning page here where you can follow it through the steps either for Plan D or Advantage plans or both.

I could take you through every step here, but as it turns out, Portland, Oregon's local newspaper, The Oregonian, has just published an easy-to-follow instruction video. Here it is.

(Note that the online pages may look somewhat different from those in the video, but the information is the same.)

Because this was produced in Oregon, the telephone help line number at the end of the video is for Oregon residents only. You can search for help where you live by Googling something similar to “choosing a part D plan in [state]”.

Or, you can telephone Medicare (1.800.MEDICARE) where a representative will help you through the entire process however long it takes.

Or, you can find personal help in your state through the nationwide State Health Insurance Assistance Program (SHIP) at this website. I've known several SHIP helpers and they are smart, well-trained and extremely knowledgeable people.

JUST DO IT
Okay. You have six weeks to get this done. With Part D, it is important to work your way through the minutiae of formularies, tiers, deductibles, etc. to find the best plan for you.

It's tedious, but doing it last year over two days in short bursts, I saved a lot of money on the Part D premium, deductible and copays. My drugs still cost me a small fortune and dumped me into the infamous donut hole for awhile this past year. But if I'd kept my previous policy the drugs would have cost a lot more.

THE DONUT HOLE

There are good changes to the Part D donut hole in 2019. It is complicated to explain and I've already carried on too long. There is a explanation at Kaiser Family Foundation.



Comments

Thank you for taking the time to remind us and inform us.

I can’t find anyplace where it lets you compare the cost of the supplement plans (not the advantage plans). Anyone know if such a place exists? I’m in California.

Good summary of a complicated exercise that doesn't seem to get any easier with each
year! Thank you!
Insurers with Advantage plans in my state offer many coverage plans, each with a different
premium cost. Among the plans are both a hybrid HMO-POS and a PPO.
With those two, a subscriber can choose any doctor to see if the physician (or ancillary
provider) is "in network." Very few, if any, doctors or supportive services do not accept the
insurance and are, as a result, in the insurer’s "network." Costs, not plans, vary from county to
county. If you meant “network” as opposed to “roster,” then there isn’t a conflict in terminology.

However, each one also requires that you use their roster
of physicians, hospitals and other service providers.


My particular Advantage Plan (an HMO-POS) does not require that I see those among the
roster of physicians (or support services) associated with the insurer. I can access services as long
as a provider accepts my insurance, which, as it happens, the three major (unrelated to one
another) hospital systems in my area do.
I’ve been on Medigap and in Advantage so am well aware of the differences! And, yes, should
I be “out of network” there will be a %-of-fee charged for services rendered (unlike a Medigap
policy).
Again, thank you for helping us navigate these choppy waters!
Jan

Laurel...
Purchasing supplemental plans is not part of the fall enrollment period so they are not included in Medicare's comparison tool and I have not addressed them in this post. It's too long as it is.

I was so content with my first Medicare Advantage company. They were local, only in Colorado, and it always seemed like I was dealing with friendly neighbors. Last year they were taken over by a large national company. I refused to switch to that company because staff at two different doctor's offices warned me they were difficult to work with and urged me not to use them. So a year ago I had to search around for a different company. They've been okay to work with, but practically hover over me wanting to do at-home physicals and giving other advice (none of which is needed or appreciated). The first company got me through my cancer treatment without a hitch and I worry that should the cancer recur, this new company is not going to be as good.

Meanwhile, regarding the New York Times article Ronni cited, over the summer the Univ. of Colorado medical center and hospital, where I get all my cancer-related care, announced they would no longer accept insurance from the very company I'd been warned against ("...does not follow the normal reimbursement and appeals process for Medicare Advantage claims") . That's a lot of specialists than will no longer be available to a lot of patients. I bless the staff that cautioned me against using that company! Talk to the nurses, bookkeepers, and receptionists, not the doctors.

Laurel....

I only have basic Medicare A&B at the moment, but am considering expanding it now. I will use a broker ...as Googling about on the internet can be very confusing to a "cyber-weenie" like me. If you’re thinking of buying health insurance for yourself or your family, you might want to consider using a California health insurance broker.

Brokers represent an extensive network of professionals who help consumers obtain health insurance at NO EXTRA FEE. They are certified with Covered California and licensed with the state’s department of insurance. Through them, you can find the best medical coverage at affordable prices. I hope this helps you as much as it did my son, in California.

My husband has been on Medicare since 2015. I joined the ranks last August. (The champagne cork popped at midnight August 1, after 2.5 years of expensive COBRA. Fun fact: You can get 36 months on COBRA — instead of the usual 18 — if you were insured through your spouse’s employer and he or she is on Medicare.)

We chose the Advantage plans, since our trusted, longtime family practice physician is in network. The few drugs we take are generics, and we get a 90-day supply at no cost. We also get Silver Sneakers, and can use three nearby gyms at no cost.

I’m switching insurance companies this year because mine is dropping Silver Sneakers in favor of an online program that features wellness videos and a “suggestion” that local gyms offer seniors a discount. My husband’s Advantage company is keeping Silver Sneakers, so I’m switching to his.

This year we are changing my husband’s plan too. He was on the plan that costs $29 a month, because of the dental and vision benefits. Now that he’s retired we thought: Yes, we love our trusted, longtime dentist, but he does not accept Medicare. You’re retired now, so why drive all that way downtown? Why not find a good dentist near us?

We tried. Bad experience. Went crawling back to our old dentist (who, incidentally, said that no, my husband did NOT need all that expensive work the other Medicare-approved dentist wanted to do....hmmm). Had a less horrible but similar experience with an eye doctor. Now we have separate dental insurance and pay out of pocket for eye exam and glasses. My husband is switching to the $0 a month Advantage plan.

We are lucky to have an in-network doctor we trust, and we live in a state that is 6th in the nation for percentage of doctors that accept Medicare. We decided to go with Advantage instead of regular Medicare partly for the extra benefits but also because we like our doctor so much. No need to shop around. Our recent experience with dentists was cautionary for us: If you move because you’re now retired, expect that experience over and over, with car mechanics, hairdresser, you name it.

Comparing Part D plans is one thing if you're already on specific prescription drugs but if you're not on any, it seems like a total crapshoot since there's no way to predict what one's drug needs will be in the coming year.

What rational person could possibly think that this is an acceptable solution to a problem?

Thank You! Once again you help me understand a little more clearly this very complicated system we have to deal with. You are without peer in clarifying this sort of thing!

Thanks for the roadmap to this year's Medicare maze. Single payer healthcare (Medicare for all) should make this path even easier to navigate. I'm not holding my breath.

Ronnie’s Ark

Thank you for everything you give us.

Ellen Francine Fields

I vote for "This End Up"

Wonderful double entendre.

Curiosity

I turned 64 this year in June but still work full time and pay out of pocket a portion of my health care, medical dental vision and life ins. costs me a total of $59.00 per week. Am I still require to sign up for medicare? If so is it going to cost me? Will I need to have both medicare and pay my employers required health insurance? I don't use medical coverage that I have now, thank God for this, but at this age one doesn't know from one day to the next, right?

Is there anyone out there still working full time with medical insurance that can help answer my questions?

Thank you

Verify your Comment

Previewing your Comment

This is only a preview. Your comment has not yet been posted.

Working...
Your comment could not be posted. Error type:
Your comment has been posted. Post another comment

The letters and numbers you entered did not match the image. Please try again.

As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.

Having trouble reading this image? View an alternate.

Working...

Post a comment

Your Information

(Name and email address are required. Email address will not be displayed with the comment.)