As fall is upon us, it is also open enrollment season for many. For individuals who are 65 and over or eligible through disability, Medicare open enrollment runs October 15 through December 7. During Medicare open enrollment, individuals can review any upcoming changes to their Medicare Advantage or Part D coverage and make needed changes. An individual can:
- Join a new Medicare Advantage Plan or stand-alone Part D plan
- Switch from Original Medicare to a Medicare Advantage Plan
- Switch from a Medicare Advantage Plan to Original Medicare (with or without a stand-alone Part D plan)
Changes made during fall open enrollment take effect January 1. Medicare beneficiaries are advised to review and make any needed changes to their existing Medicare coverage (e.g., a Medicare Advantage Plan or a stand-alone Part D prescription drug plan) during the open enrollment period. 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 2020. To find out which plans are available, start by using Medicare.gov.
What else is new for 2020?
New Plan Finder: A new version of Medicare Plan Finder (MPF) is being rolled out beginning during 2019 fall open enrollment. While the new MPF tool has more technical capabilities than the old one, concern about the timing of the roll-out just before open enrollment has been expressed by enrollment assisters, State Health Insurance Assistance Programs (SHIPs), brokers, advocates, and others. Unfortunately, there will be no ability to revert to the legacy system should the new MPF be untenable for enrollees to use. For more information about the new version of MPF, please see this Next Avenue article.
Donut hole closure: Starting in 2020, “donut hole” costs will decrease for both brand-name and generic drugs. A beneficiary enters the donut hole when their total drug costs—including what they and their plan have paid for drugs—reach a certain limit. For most plans in 2020, this amount will be $4,020. Once in the donut hole, a beneficiary will pay 25% of the cost of generic drugs and brand-name drugs. In 2019, beneficiaries paid 37% of the cost of generic drugs and 25% of the cost of brand-name drugs while in the donut hole.
Medigap changes: In 2020, Medigap Plans C and F will be discontinued for those beneficiaries who are newly eligible for Medicare on or after January 1. These plans (including the high-deductible Plan F) cover the Part B deductible. The Part B deductible cost has been trending upwards for the past several years and is set to do so again in 2020—though numbers are not yet final. The Part B deductible was $185 in 2019 and is estimated to increase to $197 in 2020. Enrollees who had Medigap Plans C or F before 2020 will continue to have coverage of the Part B deductible, but those who are eligible for Medicare on or after January 1 will not be able to purchase a Medigap policy that pays for the Part B deductible.
Medigap Plans D and G provide coverage for the same out-of-pocket costs as Plans C and F, with the exception of the Part B deductible. Plan G will now have a high-deductible option, and payment of the Part B deductible will count toward the Plan G deductible.
Other projected changes to Medicare cost-sharing in 2020 include an increase in the Part A inpatient deductible for hospital stays, which will be $1,420, up from $1,364. Furthermore, the standard monthly premium for Part B is likely to increase from $135.50 to $144.30.
Potential policy changes: The Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act saw movement in Congress earlier this summer in the form of a late June committee mark-up. The BENES Act aims to modernize the Part B enrollment process by improving outreach and education to consumers and thereby helping prevent gaps in coverage and unnecessary late enrollment penalties. The Beneficiary Education Tools, Telehealth, and Extenders Reauthorization (BETTER) Act also focuses on outreach and education, paying particular attention to low-income beneficiaries and seeking to make the Part D Limited Income Newly Eligible Transition (LINET) program permanent. Lastly, companion legislation was introduced in the House for the Medicare Extra Rx Act. The purpose of this bill is to improve the Part D Low Income Subsidy, also known as Extra Help, by eliminating the asset test and expanding subsidy eligibility up to 200% of FPL.
Need more help? For more information on Medicare eligibility and enrollment, Medicare-eligible individuals should receive a copy of the Medicare & You handbook each year—and it is also now available online. To find free, local, in-person Medicare answers, contact your State Health Insurance Assistance Program (SHIP). You can also find online answers to an array of Medicare questions at the Medicare Rights Center’s educational website, Medicare Interactive.