Medicare Your Coverage Options

Medicare Open Enrollment in 2019

Written by Diane Archer

Medicare Open Enrollment begins on October 15 and runs through December 7. Whether you are enrolled in traditional Medicare and have a Part D prescription drug plan or you are in a commercial Medicare Advantage plan, your premiums and other out-pocket-costs and in-network providers are likely changing. So, it’s wise to take a hard look at your Medicare options for next year.

Medicare Advantage and Medicare prescription drug health plan costs and benefits often change significantly from one year to the next. Although you can’t know whether a health plan will meet your future health care needs, you may be able to save money by switching.

Before you make your choice, keep these facts in mind. Whichever Medicare plan choice you make, you need Medicare Parts A and B, so you must pay the Medicare Part B premium.

  • Traditional Medicare, the government health insurance option, 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 can fill most if not all coverage gaps with supplemental insurance—Medicaid, retiree coverage from a job or “Medigap,” a Medicare supplemental insurance plan you can buy–all of which cover most or all of your deductible and coinsurance costs. 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. The copay or coinsurance can be very high and unpredictable, a percentage of your hospital bill, and your out-of-pocket costs for in-network care alone can be as high as $6,700 a year. Your 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 to get the care you need with little or no out-of-pocket costs. With Medicare Advantage plans, you have only restricted access to doctors and hospitals and your out-of-pocket costs can easily reach the $6,700 limit for in-network care. Your costs can be even higher if you are hospitalized and are forced to use out-of-network doctors, a fairly common phenomenon, or if you want to use specialists out of network. FYI: Medicare Advantage won’t release data showing people’s typical out-of-pocket costs. However, we know from the HHS Office of Inspector General that Medicare Advantage plans engage in widespread inappropriate denials of care and coverage.

Keep in mind that even if you need few health care services today, it’s unforeseeable when you might need a lot of care.

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 call your doctors and check with your health plan 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. 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.

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