You know it is Fall when you find Pumpkin Spice dog food and Pumpkin Spice Cheerios in the supermarket and then when you return home you open your mail to a new batch of solicitations for Medicare Advantage insurance plans.
Yes, it is Medicare Open Enrollment time again and again it is time to review the kinds of health insurance available to you if you are age 65 or over. The problem is that, with all the glossy brochures it is very difficult to discover what the plans offer. It can even be difficult to determine whether you need to act at all.
Here are some early tips.
Can I skip reviewing my plan or do I need to take action now? If you currently have a Medicare Supplement (also called Medigap) plan – the type of plan that consists of Medicare plus additional coverage for co-pays, deductibles and so forth – and you are happy with it now, you are not subject to the Open Enrollment period and you probably do not need to act now. You might consider reviewing your Medicare D prescription coverage which is separate.
When is Medicare Open Enrollment for 2020 Coverage? Medicare Open Enrollment for 2020 for Medicare Advantage Plans and for Medicare Part D prescription plans runs from October 15, 2019 to December 7, 2019 to begin coverage January 1, 2020. Also, if you are just becoming eligible for Medicare (such as just turning age 65), you can sign up as soon as you become eligible regardless of the month and can choose whether you want a Medicare Supplement or a Medicare Advantage plan.
I have an employer plan that covers me for everything. Do I need to sign up under Open Enrollment. If you are 65 or over and have a qualified employer health insurance plan especially working for a larger employer, you probably do not need to be concerned. If not certain of your status, check with your HR Department.
What Is a Medicare Advantage Plan? Medicare Advantage includes Medicare HMO and PPO, PFFS and others. Each year, if you are in a Medicare Advantage plan or Medicare D prescription drug plan, you can change your enrollment to another Medicare Advantage or Medicare D plan between October 15 to December 7 effective the following year if you think that another Medicare Advantage or Medicare D plan might work better for you. If you have a Medicare Supplement plan, you do not need to be concerned about Open Enrollment unless you want to change to a Medicare Advantage or change or add your Medicare D (prescription drug) coverage.
Do I Need To Do Anything During Open Enrollment? Not necessarily. If you have coverage and are content with what you have, you can just ride out the period until next year. Open Enrollment just gives you a chance to review your coverages and decide whether you want to change.
Is there anything I need to know about changing plans? When you are first enrolling in Medicare, you have the right and the ability to choose to enroll for a Medicare Supplement plan without regard to health. Medicare Supplement plans are typically more expensive and sometimes, to save money, enrollees might initially sign up for a Medicare Advantage plan. If they do and later experience poor health they can be denied the ability to switch to a Medicare Supplement for better coverage because medical underwriting is involved for the change. If you are already in a Medicare Advantage plan, you can switch to another Medicare Advantage plan without medical underwriting. If you are already in a Medicare Advantage plan and want to switch to a Medicare Supplement you would need to undergo medical underwriting with the insurance company to be approved.
What kinds of Medicare Advantage Plans Are There? Not all Medicare Advantage plans are the same. A Medicare Advantage HMO might or might not limit your providers. It is less likely to be “portable” that is to provide coverage if you move to another coverage area, another state or another part of the country than, for instance, a PPO. Medicare Supplement plans (not Medicare Advantage) are accepted wherever Medicare is accepted.
If you are confused, get help. The Chester County APPRISE program staffed by volunteers, is excellent. It can be contacted at 610-344-6035.
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.