Medicare Open Enrollment Starts October 15th

October 12, 2018 | Heather Bates, Transform Health and Rachel Bennett, Medicare Rights Center

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Fall is quickly becoming open enrollment season for many. For those are not eligible for Medicare and are interested in health insurance through the marketplace made available through the Affordable Care Act (ACA), open enrollment generally runs November 1 through December 15. States with their own marketplace can extend these deadlines. Open enrollment for people with Medicare runs October 15 through December 7.

Across the country, there are over 59 million Medicare beneficiaries, with the highest concentrations in a handful of states, including California, Florida, Texas, New York, and Pennsylvania. During Medicare open enrollment, these individuals can join a new Medicare Advantage plan or Part D plan, or switch between Original Medicare and Medicare Advantage. Medicare beneficiaries are advised to review, and make any needed changes to, their existing Medicare coverage (e.g., a Medicare Advantage plan or a Part D prescription drug plan) in this timeframe. For example, if a beneficiary’s drug plan will no longer cover a drug they take, they can use this time to choose a new drug plan for 2019, with coverage taking effect January 1. Not all are enrolled in a Medicare Advantage plan or a Part D plan, but many are, and so this time of year brings important decisions for beneficiaries and their families, as plans and formularies may change. To find out which plans are available, start by using Medicare.gov.

What else is new this year?

Medicare beneficiaries are receiving new Medicare cards in the mail. Advice about using the new card and delivery status are publicly available via Medicare.gov.

As most may know, Medicare is constructed as a cost-sharing system set by formula. In 2019, several Medicare cost-sharing changestake effectSpecifically, the Part A inpatient deductible for hospital stays will be $1,364, an increase of $24 from 2018. The standard monthly premium for Part B, which mostly covers outpatient costs, is $135.50 in 2019, an increase of $1.50–though about two million beneficiaries are held harmless to this increase. The annual outpatient deducible for Part B will be $185, an increase of $2 from 2018. The standard, basic plan premium for Medicare Part D will be $32.50, a decrease of $1.09 from 2018.  For consumers in private Medicare Advantage plans, cost-sharing is based on the plan. Overall, average Medicare Advantage plan premiums will decrease by $1.81.

Another important note for 2019 is that occupational, speech and physical therapy caps under Medicare are gone. For 20 years there have been limits on these treatments, capped at what advocates and providers indicate are arbitrary amounts that have not taken into account overall health or treatment goals. There are still  things that need to getworked out when it comes to implementation, and providers need to be sure they are using the right billing codes, but going forward, these caps no longer limit the treatments required to help people get healthy and stay healthy.

Finally, as a result of the Affordable Care Act, the Part D coverage gap, or “doughnut hole,” closes. While the enactment of the ACA moved to close this coverage gap, a large federal spending bill that Congress passed last March will close the gap even soonerfor brand-name drugs. It does so by requiring certain pharmaceutical manufacturers to pay more of the costs for plan enrollees who are in the gap.

To find free, local, in-person help for any of the above, contact your State Health Insurance Assistance Program (SHIP). Medicare beneficiaries should receive a copy of the Medicare and You handbook each year, which is also now available online.

Check out the consumer-friendly resources that explain cost-sharing, provide guidance on enrolling in Medicare, and more at the Medicare Rights Center’s educational website, Medicare Interactive.

If you are interested in additional information about any of the above or would like to work with Transform Health, please email Heather Bates at heather@transformhc.com.