Changes You Need to Know About Medicare

It's open enrollment season for Medicare beneficiaries.

And, as in past years, there are changes, especially with Medicare Advantage plans, that might trip you up if you're not careful, says Katy Votava, president of Goodcare.com and author of Making the Most of Medicare: A Guide for Baby Boomers.

One of them, said Votava, has to do Medicare Advantage plans, and specific medications that some people may be taking most likely in a clinic, and expensive injectable medication, whether it's for cancer or some other treatment. "And the changes this year that people who have Medicare Advantage plans may be facing a 20% co-insurance for that as opposed to a clinic visit co-pay," she said in a Retirement Daily podcast.

Thus, a medication -- an injectable that might cost $10,000 -- will cost someone $2,000 for the 20% co-insurance in 2019.

Votava's advice: Review your Medicare Advantage plan benefit summaries, especially the section for Medicare Part B and determine if you'll face increased charges for medications you get, particularly in outpatient clinics.

And if you are facing a cost shift, Votava recommends first looking to see if another Medicare Advantage plan in your area that doesn't have this type of co-pay structure and percentage for drugs. "They vary down to the county and zip code level," she said.

And second, "what would work for many people," she says, is to purchase a Medicare Supplement Insurance or Medigap policy, best case, Plan F or Plan G."

"These plans will cover their out-of-pocket costs when they use their Medicare Part B benefit, and then add what's called a standalone drug plan," Votava said. "Now, that sounds kind of complicated and it can be, so they need to get the show on the road to look for a Medigap plan."

A Medigap policy helps pay some of the healthcare costs that Original Medicare doesn't cover, such as copayments, coinsurance and deductibles.

Votava noted that people who are older than 65 and three months might find some underwriting and might not be able to change into a Medigap plan, but they might be able to. "If you have a Medigap plan, there's no network involved in their pricing structure and their cost structure doesn't exist in those Medigap plans the way it does in Medicare Advantage plans," she said. "So that's another way to go -- replace that Medicare Advantage with a Medigap plus a standalone drug plan."

According to Votava, Medicare Advantage beneficiaries can select their plans now, during open enrollment season which runs to Dec. 7, 2018 and, starting in 2019, a new Medicare Advantage open enrollment period will run from Jan. 1 to March 31 every year.

Votava doesn't recommend that Medicare Advantage beneficiaries change their plans too often if they don't need to. But if they can't change their Medicare Advantage/Medigap plans before Dec. 7, they can do so in the first quarter of next year as soon as possible. "And, particularly, if you're going to move to a Medigap plan plus a drug plan, I recommend that people look for the Medigap plan first, do that application, find out if they're accepted," she said. "They might have to apply to more than one company, they might not. And then subscribe for a new Medicare Part D because if you change out of a Medicare Advantage plan in the first quarter of next year, you are entitled to pick up a new standalone D plan at that time."

In a recent brief, the Kaiser Family Foundation (KFF) provided an overview of the Medicare Advantage plans that will be available in 2019, based on an analysis of data from the Centers for Medicare and Medicaid Services (CMS). In a separate report, KFF noted that people on Medicare will be able to choose among 24 Medicare Advantage plans and 27 Medicare Part D drug plans, on average, during the open enrollment period for 2019.

According to KFF, more than 20 million Medicare beneficiaries (34%) are enrolled in Medicare Advantage plans, which are mainly HMOs and PPOs offered by private insurers as an alternative to the traditional Medicare program.

 

Author: Robert Powell
Source: TheStreet, Inc.
Retrieved from: www.thestreet.com
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