Medicare Open Enrollment for 2019: What You Need to Know

Open Enrollment Road Sign

It's that time of year again! No, not the holidays—Medicare open enrollment. What exactly is Medicare open enrollment? It's a period each year (October 15-December 7) during which Medicare users have the opportunity to reassess their coverage and compare part of their current coverage (Medicare Part D and/or Medicare Advantage) against the other plans available. During open enrollment, if you realize that another plan would be better for your current needs, you can make changes. These include switching to another Medicare Advantage or Medicare Part D plan, or dropping or adding that coverage.

As a reminder, Medicare Part A is hospitalization insurance and Medicaid Part B is for outpatient services. You cannot use open enrollment to sign up for this coverage for the first time. Medicare Advantage is also referred to as Medicare Part C. It is essentially a private health plan from which you would get Part A and B coverage, as well, potentially, as drug coverage. If you have Medicare Advantage, you may get your care within a specific network of carriers involved with your plan.

Medicare Part D is a program created by the federal government to help reduce the cost of your prescription medication. Medicare Part D is administered by private insurance carriers within your local area, rather than through the Social Security office.

What's New With Medicare Open Enrollment for 2019?

There will be a greater variety of Medicare Advantage plans available for 2019, as well as an expected increase in Medicare Part D options. The monthly premium for Part D plans is also decreasing slightly, as are premiums for Medicare Advantage plans. However, you can expect to pay higher co-payments for out-of-network care with Medicaid Advantage in 2019.

Some Medicare Advantage plans will begin offering new benefits that have not been available through original Medicare. These include some dental and vision benefits, and even memberships to some health clubs.

There is a Medicare Advantage Disenrollment period that has traditionally been from January 1-February 14 every year. Starting in 2019, this period will be replaced with a new Medicare Advantage Open Enrollment Period. Starting in 2019 and continuing in subsequent years, this period will run from January 1-March 31 annually. Medicare Advantage enrollees will have a one time opportunity to:

  • Change enrollment to a different Medicare Advantage plan than they currently use
  • Drop Medicare Advantage Enrollment and re-enroll in the original Medicare program
  • Enroll in a Medicare Part D prescription drug plan if you have dropped Medicare Advantage in favor of returning to original Medicare.

Because most Medicare Advantage plans do include coverage for prescription drugs, you probably don't have separate Medicare Part D coverage if you are enrolled in Medicare Advantage. If you do decide to drop your Medicare Advantage coverage and re-enroll in original Medicare, you will probably want to consider a stand-alone Medicare Part D plan. Original Medicare covers some prescription drugs, but only on a very limited basis, such as if you are admitted to the hospital.

What to Consider During Medicare Open Enrollment

There are certain essentials that you have no doubt taken into account when choosing your Medicare coverage in the past, like benefits and cost. While those things may be paramount in your decision-making process, there are other things you should look at, too.

There are certain essentials that you have no doubt taken into account when choosing your Medicare coverage in the past, like benefits and cost. There are other things you should look at, too.

Many seniors take a variety of medications, and therefore, pharmacy access and convenience is important. If the pharmacy you prefer to use is not in-network for your drug plan, a switch may be in order. Whether a particular pharmacy is in-network can change from year to year, so if you like your pharmacy, make sure it's in your plan's network before you commit to the plan.

Similarly, make sure that your preferred doctors and other health care providers accept your plan's coverage. You may pay less for care if your preferred hospital and providers are in the plan's network. As with pharmacy coverage, coverage for certain doctors and hospitals can change from year to year, so make sure that your plan will offer what you have come to expect.

Another consideration in making your Medicare decisions is travel. If you are taking advantage of the opportunity to roam about the country, and even the world, during your golden years, make sure the Medicare plan you have will cover your needs wherever you may go.

Last but not least, think about the quality of the care you have been receiving. Many of us stay with what we know, but take some time to really consider your level of satisfaction. Are you staying with a certain doctor or practice because they are familiar, even if you find yourself grumbling after every appointment? Your choice of care provider can have a direct and lasting impact on your health. Changing your coverage can change your access to different doctors, and potentially better care.

To learn more about Medicare open enrollment, visit medicare.gov or contact our law office with any questions.

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Categories: Elder Law, Medicare

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