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Annual Medicare Enrollment Period has Arrived

EDITORIAL NOTE: This is so far from comprehensive as to be a joke but I hope it will give you an overview of the basics of Medicare and how they apply in the annual enrollment period.

Because this post is longer than usual, I've used bolding and lists to make it easier to navigate and get to the sections that interest you most.

* * *

It's that time again – Medicare Annual Open Enrollment begins tomorrow, 15 October, and lasts through 7 December. During this period of 54 days you can:

⏺ Switch from traditional Medicare to Medicare Advantage (MA)

⏺ Switch from Medicare Advantage to original Medicare

⏺ Select a different Medicare Advantage plan if you have one now

⏺ Enroll in a Part D prescription drug plan

⏺ Change to a different Part D plan if you already have one

If you are new or newish to Medicare, it can be daunting. Medicare is a massive program and I'm pretty sure that even people who are certified to help the rest of us figure it out don't know all of it.

In that regard, there is a short list of links at the bottom of this post for more detailed or personalized information.

Here are the various Medicare parts:

Part A: Part of traditional Medicare, it covers hospital and hospice care along with some skilled nursing services after a hospital stay. There is no premium for Part A.

Part B: Part of traditional Medicare, it covers doctor visits and certain outpatient services. The Part B premium is deducted from your monthly Social Security payment and will be about $144.30 in 2020, up from $135.50 in 2019. The exact amount has not been announced yet.

Parts A and B constitute traditional Medicare. You may choose any doctors who accept Medicare.

Part C: Medicare Advantage (MA), issued by private insurance companies, is required to include traditional Medicare Parts A and B (at the same premium as traditional Medicare) and often includes Part D along with limited coverage for vision and dental care, for example.

MA takes the place of traditional Medicare. (Some companies charge no premium.) You are restricted to their network doctors.

Part D: Helps pay for prescription drugs. Part D is private coverage for which you pay a separate monthly premium if you have traditional Medicare.

Medigap: Also called Medicare Supplemental, is private coverage that helps pay for what Medicare does not, such as co-payments, co-insurance and deductibles. Restrictions apply as to who can buy Medigap coverage and when.

MEDICARE AND YOU HANDBOOK
The Medicare and You Handbook has many explanations and answers. You can download an electronic copy online. There is a wide choice of editions: PDF, large-print PDF, ebook for your Kindle, iPad, etc. You can also telephone to have a CD audio version, a Braille version or the paper edition mailed to you.

The telephone number is 800.633.4227 or visit the webpage.

This booklet is well organized, clearly written and as easy to use as anything related to Medicare can be.

MY MEDICARE
The official Medicare website is at medicare.gov. Check the dropdown menus at the top of the page for many specific questions.

If you have not signed up for My Medicare which personalizes the Medicare website for you, you can do that on this page. It can help a lot.

When I signed in to My Medicare to check my Part D coverage a couple of days ago, all my current prescriptions were already listed for me – names, dosages, quantities for each refill, and frequency of refills. All of it was correct.

If any of my prescriptions had changed, this is were I could edit them or add and subtract drugs as needed.

In my state, there are 28 Part D plans available, most with a deductible. With just a mouse click, I could see details of each plan and select up to three-at-a-time to compare with one another and check that my drugs are still covered.

That's important. It can change from year to year and, of course, each company's formulary is unique to it.

A recent mailing from that plan advised me that if I wish to continue for 2020, I don't need to do anything. My plan will roll over to next year.

You can also check drug prices of plans at several pharmacies near you and at mail-order pharmacies.

It took me about two hours to work through all the information and make my choice. I use seven prescription drugs. If you have more, it will take longer but the interface makes it relatively easy with one caveat: the plan finder is newly updated and may contain some glitches.

The above applies only to Part D in connection with traditional Medicare. If you have Medicare Advantage or are switching to it, you're on your own. MA is a mystery to me but Medicare's MA Plan Finder works similarly to the Part D Plan Finder.

PERSONAL SUGGESTION NO. 1: If you do not use any prescription drugs, choose the least expensive plan. Since there is no way to predict what might go wrong and therefore what drugs you would need, nothing else makes sense.

When I was diagnosed with cancer and began using prescription drugs, there was one not covered by my plan. Fortunately, it was not too expensive but in the next enrollment period, I chose a Part D plan that covered all my drugs.

(Yes, it is a stupid idea to make people choose a plan when they don't know what they will need it for. Complain to your representatives in Congress.)

PERSONAL SUGGESTION NO. 2: I was prescribed a new inhaler this year. When I was told my part of the price, I nearly passed out – about $500 per month. I told the pharmacist that was out of the question and prepared to see what else the doctor could recommend.

But the pharmacist told me that drug companies will reduce the price considerably in many circumstances, that I would need a declaration signed by my physician and that they, the pharmacy, would take care of all the paperwork.

In less than a week, the drug company approved me and the price dropped to just over $100. So if the price is high, ask what can be done. Pharmacists are well informed and helpful.

WHAT'S NEW IN MEDICARE FOR 2020
Medicare Advantage may now cover such items grab bars, rides to and from medical appointments, acupuncture, massage therapy and more. They are offered at the plan's discretion and only for certain health conditions. This applies only to Medicare Advantage and not to traditional Medicare.

At last, the Medicare Part D doughnut hole (coverage gap) goes away completely in 2020. However, the new limit for out-of-pocket expenses increases from $5100 in 2019 to $6,350 in 2020. Part D plan members will now pay 25 percent of the cost of generic and brand name drugs.

Once you have reached that $6,350 threshold, you pay five percent of a drug's cost.

WHERE TO FIND PERSONALIZED MEDICARE HELP
You can get personalized help as you ponder your open enrollment decisions.

MEDICARE
Medicare.gov has an online chat feature available during open enrollment, and the Medicare hotline, 800-MEDICARE (800-633-4227), is open 24 hours a day, seven days a week during the annual enrollment period.

SHIP (State Healthcare Insurance Assistance Program)
These state-based organizations offer help with Medicare questions, including your benefits, coverage, premiums, deductibles, and coinsurance along with help for joining or leaving a Medicare Advantage Plan, any other Medicare health plan, or Medicare Prescription Drug Plan (Part D).

Locate a SHIP representative in your state here.

Another SHIP list by state from Seniors Resource Guide. This list is up to date as of October 2019.



Comments

Thanks for the really helpful primer on Medicare. I've been on the program for five years, and still am learning a few things. Just one comment: If your item under Personal Sugg. No 1 is a "stupid idea" -- and it is -- then your item under Personal Sugg. 2 is just as stupid -- offering one price for a drug, and then another secret price that you can apply for and possibly get but you have no idea what the criteria are.

If only Medicare could be less complicated and more transparent!

Why we continue this Rube Goldberg system is beyond me. Universal Healthcare period. For everyone period.

Thanks Ronni. Very helpful information.

Thanks for the service, Ronni. Although we have supplemental and prescription coverage through my husband's former employer, I am the one who is responsible for keeping up-to-date on our insurance. The other day, my husband asked me about what insurance covers what - but - he is congenitally unable to listen to me talk for more than 30 seconds. This morning, I sent him an email with an excerpt (explaining the various parts of Medicare etc) from your posting. Well done!

I speak from recent experience with a close family member who chose an inexpensive Advantage plan because “she had never been sick before .”

Just a few months into Medicare she was diagnosed with a rare and complicated terminal illness, except the treatment goes on for years and this particular illness affects every organ in the body sooner or later. Every month their insurance statement is 69 or 70 pages long. Treatment every year could easily top $1 million.

Fortunately they have an out-of-pocket medical maximum but they will still be paying that $10,000 a year as long as this relative is alive. In addition to whatever crazy cost of drugs which is impossible to predict.

Please don’t choose your future medicare plan based on your past good health. None of us gets out of this alive and for many it may be very very costly to exit this life. With a pre-existing condition such as hers it is now impossible to change over to original Medicare that covers everything.

When we became Medicare eligible, we were assisted in figuring it all out by a friend who volunteers with HICAP (same as SHIP - State Healthcare Insurance Assistance Program I think). It made a huge difference. We are professional people who wouldn't think we'd need such an agency, but we were very glad we could use this one. Don't be put off by asking for help from "an agency."

Regrettably, the company that administered my first Medicare Advantage plan, the one that paid almost all of my cancer-related expenses, was taken over by a company that I was warned against and that is no longer accepted by my university cancer center (precisely because that company is so difficult to deal with). So I'm with a new company and am not at all sure what my expenses will be if the cancer recurs. I've done my best to learn all the details, but anxiety persists.

Universal health care would sure be the answer, but......

My deceased husband’s company still offers me the eligible retired spouse plan and I can choose two original Medicare plus medigap plans (both include drugs) or two different advantage plans with drugs.

The MA are definitely cheaper, but the main thing I notice is if you have to be in a hospital or nursing facility for a long length of time..100 days, the coverage is much better in original Medicare, as far as how many days covered free.

It becomes a gamble on your future health, which is so unfair.

And trump is pushing MA programs, as the private insurers will make a lot of money and so will the stock holders. It always seems to be about money doesn’t it?


You may be able to switch from Medicare Advantage to Medicare depending on state rules. Having different rules in different states further complicates matters.

Of course it's all about the money--isn't everything in a "vulture capitalist" environment such as the would-be Empire of Trumpistan?

How good of you to post such a comprehensive and thoughtful piece on Medicare, and the various points to consider.

I would URGE everyone who is new to Medicare to sign on to Part D, as soon as you sign up for Medicare!

In my own case, I looked at what my prescriptions totaled when Part D first became available, and realized that the cost of my meds was considerably less than the cost of Part D, so opted out of that part, thinking I could pick it up later when I needed it.

Unfortunately by the time I decided, several years later (maybe 5 - 6 years after) I was told that although I could apply for it, and sign up for it, in order to do so I would have to PAY FOR EVERY MONTH THROUGH ALL THE YEARS THAT I HAD NOT TAKEN PART D BEFORE IT WOULD KICK IN! (Sorry for the caps, but it is so important to realize that fact!) Well, as you can imagine, that added up to a huge amount. I decided not to do it as that would have been way off the charts even though at that point I was indeed taking quite a few meds.

Now that I am 90, I seem to be taking quite a few, even though I feel quite healthy. Currently taking about 12 per day, plus vitamins and fish oil. The latest, was going to cost me nearly $1,000. per month (heart med.) and I declined to take it as I have no income other than social security, and savings are quickly going!
At that point, the doctor said he would send an application to fill out, so now I am able to obtain the drug Eliquis, for free. (I'm grateful, but feel like a charity case!)

Laughing. You are SO nice to a) understand it and b) tell us! I, after 7 years on Medicare, still don't understand. And the books! The amount of paper! OY!

Then, bec my spouse is younger and not on Medicare, something at work said I could switch my part D to theirs and it might be better . It too was like reading a foreign language.

And we all have access to the internet and information. I can't imagine what most people go through deciding what to have. (I was sold on supplemental when they told me it would cover a private hospital room!)

Too many of the doctors I use don't accept Medicare or my supplemental - and to find a doc that does means starting over, traveling (by cab) miles and miles and it seems not worth it. I'm lucky that they either discount their charges and/or submit for me.

If you all were calling to ask whether to keep your own Part D v. switching,who would you call?

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