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Medicare open enrollment for 2019

Open enrollment allows you to review your plan and other options to see which Medicare plan works for you. 

Medicare open enrollment runs from Oct. 15 to Dec. 7 each year. New coverages for changes made during open enrollment begin on Jan. 1 of the following year.

Medicare's open enrollment is different than for the Affordable Care Act marketplaces, which are also called the exchanges. Open enrollment for those plans usually start on Nov. 1, but it can differ by state. 

Some seniors mistakenly think they can enroll in a Medicare plan through ACA health insurance marketplaces. But while the marketplaces will sell private individual health plans to people under age 65, they don't sell Medicare plans. People with Medicare do not need to enroll in the health insurance marketplaces.

Now, let's walk through Medicare open enrollment and what you need to know. 

Medicare open enrollment options

During the Medicare open enrollment period you can:

  • Do nothing and keep your current Medicare medical and drug coverage as is.
  • Switch to a Medicare Advantage plan from Original Medicare.
  • Switch to Original Medicare from a Medicare Advantage plan.
  • Change Medicare Advantage plans.
  • Change Part D prescription drug plans, sign up for a drug plan if you don't have one now or drop drug coverage.

CMS estimates 73 percent of Medicare Advantage plans have a quality rating of four or more stars, based on a five-star rating, in 2019. That's better than the 69 percent in 2018. 

If you're turning 65

You have three months before your birth month and three months after your birth month to enroll in Medicare. If you turn 65 this fall, you'll need to enroll for coverage to take you through the end of this year and sign up for coverage for 2018.

If you have an ACA Marketplace, workplace or individual health insurance policy, you can keep it until your Medicare coverage begins.  Once your Medicare starts, you can cancel your marketplace or private health insurance policy without penalty.  If you're continuing to work and receive group health insurance from your employer, you may be able to delay signing up for Medicare Part B (without penalties) until your employment terminates.

Part A, which covers inpatient care, is usually premium-free. So, you may want to enroll in Part A and keep your other coverage that covers outpatient and physician office visit care. 

Discuss with your employer your healthcare coverage, if this situation applies.

Review your annual Medicare changes

Your may go through changes that require you to change plans. For instance, your doctor may prescribe multiple medications or you may have a health scare. Plus, insurance companies are add Medicare Advantage plans each year. It's a good idea to review your coverage annually and see if your plan is meeting your healthcare needs. 

You should receive an "Annual Notice of Change" from your plans before open enrollment begins. Review the information to understand Medicare coverage and costs for next year. Among the questions to ask:

  • Does the prescription drug plan cover the medications you take? What are the coverage rules for drugs? Can you use your pharmacy or get mail-order prescriptions?
  • Are your doctors and hospital in the health plan's network? Do you need to get referrals to see specialists?
  • How much will you pay in premiums and out-of-pocket health care costs, such as deductibles, copayments and coinsurance?
  • What is the plan's quality rating?
  • Will you have coverage when you're out of state or the country?
  • Do you have access to other coverage, such as group health through a current or former employer? How will Medicare work with that insurance?

Two main ways to buy Medicare plans

Original Medicare

The federal government runs Original Medicare, which includes Part A and Part B. Part A covers hospital care; Part B covers doctor visits, outpatient care, lab work, X-rays and preventive services.Medicare

You likely won't pay a premium for Part A coverage if you and your spouse paid Medicare taxes while working. You do have to pay a deductible, however, before hospital coverage kicks in. You pay a monthly premium for Part B, as well as a deductible and coinsurance.

With Original Medicare ,you can see any doctor or go to any hospital that accepts Medicare.

You can add a prescription drug plan -- Part D -- to your Parts A and B plans. In Part D, private insurers sell drug plans, which are approved by Medicare. You pay a monthly premium for a drug plan. Part D plans aren't available in Medicare Advantage, but many of those plans have their own prescription drug plans. 

In addition you can buy a supplemental plan, called Medigap, to help cover some of your out-of-pocket costs. Private companies sell Medigap plans, which are standardized by letters A through N in most states.

You don't have a guaranteed right to buy or switch Medigap plans during the annual Medicare open enrollment period in the fall. The best time to buy a Medigap plan is during the first six months you're at least 65 and enrolled in Plan B.

During this period, federal law gives you the right to buy a plan, regardless of your health condition. You can still buy or switch Medigap plans later, but except in limited situations Medigap plans can turn you down or charge you higher premiums based on your health. The Affordable Care Act provision prohibiting insurers from rejecting or charging higher premiums for people with health conditions does not apply to Medigap because the stipulation is only for those under age 65. 

Medigap plans are not insurance. They help you pay for healthcare costs. 


Medicare Advantage

Private companies approved by Medicare sell Medicare Advantage Plans. These plans usually operate like health maintenance organizations or preferred provider organizations.

You must use doctors or hospitals in the plan's network, or you pay more out of pocket for care. Medicare Advantage plans are an option to Part A and Part B of Original Medicare, and most cover prescription drugs. Some plans also cover vision and dental care. You pay a monthly premium as well as copayments or coinsurance. 

Starting in 2019, Medicare Advantage plans can offer other supplemental benefits that can indirectly help a beneficiary's health, such as for transportation to doctor's appointments. 

You cannot buy a Medigap plan if you have Medicare Advantage.

Medicare prices

Medicare Advantage premiums have dropped since the Affordable Care Act in 2010. 

In 2019, the average monthly Medicare Advantage premium will drop 6 percent to $28. CMS said about 83 percent of Medicare Advantage enrollees will pay the same or lower their premiums if they stay in the same plan in 2019. Nearly half of Medicare Advantage enrollees will have no premium in 2019. 

Medicare Advantage beneficiaries will also get more choice in 2019. CMS said Medicare Advantage plans will increase from about 3,100 to approximately 3,700 in 2019. More than nine out of 10 Medicare enrollees will have a choice of at least 10 Medicare Advantage plans. That's up from 86 percent in 2018. 

Medicare Advantage enrollment is expected to continue to increase in 2019. Medicare Advantage is expected to rise from 20.2 million to 22.6 million, an 11.5 percent increase. That's about 36 percent of the Medicare population.  

How much does each type of Medicare cost? Here's a run down: 

Part A - Nearly all Medicare beneficiaries don't pay a monthly premium for Part A.  However, if you're not eligible for premium-free coverage, you'll pay $422 for Part A. The deductible is $1,340 for each benefit period. (A benefit period begins the day you're admitted as an inpatient in a hospital or skilled nursing facility (SNF). The benefit period ends when you have not received any inpatient hospital or SNF for 60 days in a row.) The average deductible for Part A is $1,364.

Part B - The standard Part B premium is $135.50, but tends to be a bit lower,.  However, if you have a high income, your costs may be higher -- up to $428.60 a month if you're getting in more than $160,00 if single or $320,000 if married. The deductible is $185 for the year. Once you meet that deductible, you usually pay 20 percent of your Part B healthcare costs. 

Part C -  The average monthly Medicare Advantage premium is $28 for 2019. That's a drop from $29.81 in 2018. About 46 percent of Medicare enrollees don't pay any premiums, but remember you get what you pay for. So, make sure the Medicare Advantage plan you choose will work for you and isn't just the cheapest on the market.  

Part D (drug plan) - Most Medicare drug plans charge a monthly fee that varies by plan. The average monthly basic Part D premium for 2019 is $32.50, which is a decrease from $33.59 in 2018. CMS also added some improvements to Part D plans, such as more access to generic drugs, which should help keep down costs. Deductibles vary, but no Medicare drug plan may have a deductible more than $415 in 2019.

The so-called "donut hole" the spending threshold when catastrophic coverage for drugs begins. During this time, beneficiaries pay a larger part of the total costs of drugs. In 2019, your initial coverage limit is $3,820. The donut hole is $3,820 to $5,100. 

Catastrophic coverage will kick in once you've spent $5,100 out of pocket on drugs for the year.  Catastrophic coverage makes it possible for you to pay a small coinsurance amount or copayment for covered drugs (5 percent of the cost of drugs) for the rest of the year. The coverage gap will close in 2020.

Part D enrollees will get a 75 percent donut hole discount on brand-name drugs purchased when a beneficiary is in the donut home ($3,800 to $5,100). You also get up to 37 percent donut hole charge on generic drugs. 

Where to get help

Visit Medicare.gov to get information about plans in your area or call 1-800-MEDICARE. You can also get help by contacting your State Health Insurance Assistance Program. The "Medicare & You" booklet is available for download on the Medicare website.

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