Medicare Your Coverage Options

2018 Medicare Open Enrollment

Written by Diane Archer

Medicare Open Enrollment began on October 15 and runs through December 7. If you are enrolled in a Part D prescription drug plan or a Medicare Advantage plan, your out-pocket-costs and/or in-network providers may be changing. It’s wise to take a hard look at your Medicare options for next year.

Health plan costs and benefits often change significantly from one year to the next. So, you may want to switch. Although it’s hard to know whether a health plan will meet your future health care needs, you may be able to save money by switching.

Even if you don’t switch now, after the open enrollment period ends, if you are enrolled in a Medicare Advantage Plan and would like to disenroll and switch to traditional Medicare, you may be able to do so between January 1 and February 14. To learn more and get free advice, call your State Health Insurance Assistance Program at 800-677-1116.

Before you make your choice, keep these facts in mind.

  • Traditional Medicare, the government health insurance option, is the Medicare health plan choice for nearly seven in ten people with Medicare.
    • Traditional Medicare offers coverage from almost all doctors and hospitals anywhere in the country.
    • Traditional Medicare generally does not require pre-authorization or a referral for medical or hospital services.
    • With traditional Medicare, you pay deductibles and coinsurance in addition to the Part B premium. However, you can fill most if not all coverage gaps with supplemental insurance—Medicaid, retiree coverage from a job or a Medicare supplemental insurance plan you can buy. Supplemental insurance protects you from catastrophic costs and allows you to budget for your health care.
  • Medicare Advantage plans, commercial health plans that contract with Medicare
    • Medicare Advantage plans generally limit coverage to a small group of doctors and hospitals in your community—the provider network–except in emergencies or urgent care situations. The provider network can change at any time with doctors and hospitals leaving and entering the network.
    • Medicare Advantage plans often charge an additional premium (on top of the Part B premium), a deductible (the amount you pay before coverage begins) and a copay or coinsurance, with each health care visit. These costs can change from one year to the next. You cannot buy insurance to fill these coverage gaps.

If you need costly Medicare-covered services, so long as you have traditional Medicare and supplemental coverage you should be able to see most any doctor and use virtually any hospital with little or no out-of-pocket costs. With Medicare Advantage plans, you will have only restricted access to doctors and hospitals and your out-of-pocket costs can easily reach the $6,850 limit for in-network care. Your costs can be even higher if people are hospitalized and are forced to use out-of-network doctors, a fairly common phenomenon, or if people want to use specialists out of network.

If you’re in a Medicare Advantage plan now:

  • Check your health plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays. If those are good with you, also check to make sure your doctors and hospital are still in the network.
  • Consider your other health plan options, including traditional Medicare. One of those options may better meet your needs. You can call your State Health Insurance Program or SHIP for help sorting through your options. You can also call 1-800-633-4227 (1-800-Medicare) or use this Medicare tool to understand your options.
  • Before making a switch to another Medicare Advantage plan, call the plan to confirm your understanding of costs and network doctors and hospitals.
  • If you want to switch to another Medicare Advantage plan, call 1-800-633-4227 (1-800-Medicare) to let Medicare know about your decision.

If you have a Medicare Part D prescription drug plan:

  • Check your Part D drug plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays or coinsurance. If those seem good to you, check the costs for the drugs you’re taking.
  • It’s wise to look at other drug plan options. You might find a plan that covers your drugs at lower cost. Medicare offers a tool for comparing drug plans based on your drug needs.

If you decide to switch plans, your new coverage will begin on January 1.

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