The annual Medicare Open Enrollment period for 2020 plans will run from October 15, 2019, to December 7, 2019.
During the annual enrollment period you can sign up or make changes to various aspects of your existing coverage. You can also switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another. And if you didn’t enroll in a Medicare Part D plan when you were first eligible, you can do so during the general open enrollment, although a late enrollment penalty may apply.
It’s very important to review your Parts C and D coverages every year during open enrollment, because the each plan’s coverages and costs can vary wildly from year to year. Most of our clients find themselves switching between plans because the benefits and premiums are so different from year to year. To do an accurate comparison between plans, you can go to medicare.gov and click on the blue tab reading, “Sign up/change plans.” Then on the left side of the page, click on “Find health and drug plans.” From there, you can enter information about the state of your health, the doctors you want to have access to, and the exact drugs you take, including dosages. When you’ve completed your entries, Medicare will provide you with a list of health and drug plans that will cover you and your drugs at the lowest possible premiums. You can then easily sign up for a new plan, if desired, directly from Medicare’s site.
If you’re already enrolled in a Medicare Part D prescription plan or a Medicare Advantage Plan and you don’t want to make changes to your coverage for the coming year, you don’t need to do anything during open enrollment, as long as your current plan will continue to be available. If your plan is being discontinued and isn’t eligible for renewal, you will receive a non-renewal notice from your carrier prior to open enrollment. If you don’t, it means you can keep your plan without doing anything during open enrollment.
Who is eligible?
If you’re over 65 (or turning 65 in the next 3 months) and not already getting benefits from Social Security, you need to sign up to get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). You won’t get Medicare automatically (and you may incur a penalty if you don’t sign up at the right time). If you already get benefits from Social Security, you’ll get Medicare Part A and Part B automatically when you’re first eligible and don’t need to sign up. Medicare will send you a “Welcome to Medicare” packet 3 months before you turn 65. You’ll still have other important deadlines and actions to take, so read all of the materials in the packet.
You need to pay attention to all of Medicare’s parts: Part A covers hospital and hospice care and some skilled nursing services after you’ve been in the hospital. Part B includes doctor visits and other outpatient services. Part C is Medicare Advantage, which is a managed care styled substitute for Parts A and B. It replaces the indemnity features of Parts A and B with either an HMO or PPO plan, with in-network and out of network types of coverages that are similar to most employer plans. Part D helps pay for prescription drugs.
Original Medicare vs. Medicare Advantage (Part C)
Medicare Advantage (MA) plans are offered through various private insurance companies (rather than through the Federal Government) and are often lower cost than traditional Medicare (with often an even wider range of benefits, including not only Part B and Part D coverage but sometimes even dental and vision coverage as well). However, MA plans encourage (or really, require) individuals to utilize providers with whom the carriers have negotiated concessions and discounts (i.e., in the Advantage plan’s “network”), which means it’s necessary to monitor the plans each year to ensure that the desired doctors are available, or otherwise switch plans to another that includes the desired doctors. And those who relocate may wish to switch altogether into (or out from) a MA plan, as the quality of network (and therefore popularity of the plans) varies tremendously from one geographic region to another. Also, one of the drawbacks of MA is that there isn’t nationwide coverage, which means you pay out-of-network rates if you travel.
Medical Marketplace (Affordable Care Act or Obamacare)
The Affordable Care Act (ACA) is the comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or
Obamacare). The law provides consumers with subsidies that lower medical insurance costs for households with incomes between 100% and 400% of the federal poverty level. If you don’t have health insurance through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source that provides qualifying health coverage, the Marketplace can help you get covered.
Note, there is no longer a tax penalty (starting in 2019) for not having medical insurance.
Here’s a handy checklist for those looking for medical coverage: https://marketplace.cms.gov/outreach-and-education/apply-for-or-renew-coverage.pdf
We’re here to help! Please reach out to our team if you have any questions about Medicare or your medical insurance coverage.