Medicare Open Enrollment – Time for a Coverage Checkup




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Nov 01, 2018

By Cathy Johnson, CPA, CGMA Chief Administrative Officer and CFO at Terry Lockridge & Dunn and World Trend Financial

Every year, Medicare’s open enrollment period is October 15 to December 7, for coverage that is effective January 1st. Medicare health and drug plans can make changes each year—things like cost, coverage, and which providers and pharmacies are in their networks. October 15 to December 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.

From the Medicare.gov website, here is what you can do during this open enrollment period:

  • Change from Original Medicare to a Medicare Advantage Plan. Medicare Advantage Plans are health plans offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that does not offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that does not offer drug coverage.
  • Join a Medicare Prescription Drug Plan (Part D).
  • Switch from one Medicare drug plan to another Medicare drug plan.
  • Drop your Medicare prescription drug coverage completely.

Here is a checklist to help get organized:

  1. Put together a detailed list of all medications. Be specific with the exact spelling and dosage shown on the prescription container. Take a picture of prescription bottles if you will be meeting with a caregiver to do this review.
  2. Make a thorough list of all health care providers, including name, contact person, and phone number. Be sure to include physical therapists, medical equipment suppliers, laboratories, pharmacies, etc.
  3. Read the new plan benefit summary and the Annual Notice of Change from your current plan. If your plans are changing, make sure their plans will still meet your needs for the following year. Look at more than the premium. Determine if there are changes in co-payments, co-insurance, deductibles, and other plan features.Will your medications continue to be covered, or not? Ask your health care providers if they plan to continue participating in your plan.
  4. If you are married, consider if you should each have different plans. Oftentimes, the medical needs of each spouse are different, so assuming one plan is good for both can be costly.
  5. Go to Medicare.gov or call 1-800-MEDICARE to find Medicare plan information and compare plans.
  6. If you are satisfied that your current plans will meet your needs for next year, and it is still being offered, you do not need to do anything.

There are a couple of new things to note going into 2019:

The 21st Century Cures Act, signed into law by President Barack Obama on Dec. 13, 2016, eliminates the existing Medicare Advantage disenrollment period that has taken place from Jan. 1 through Feb. 14. Effective for 2019, the act replaces it with a new annual Medicare Advantage open enrollment period that will take place from Jan. 1 through March 31. During this period, individuals enrolled in a Medicare Advantage plan may make a one-time election to go to another Medicare Advantage plan or traditional Medicare. Individuals using this open enrollment period to make a change may make a coordinating change to add or drop Part D prescription coverage. However, you cannot: switch from Original Medicare to a Medicare Advantage Plan, join a Medicare Prescription Drug Plan if you are in Original Medicare or switch from one Medicare Prescription Drug Plan to another if you are in Original Medicare during this January 1 – March 31 period. The time for that is during the October 15 – December 7 annual enrollment period discussed above.

Please note there is a welcome change coming to Medicare Part D prescription coverage. Starting in 2019, beneficiaries in the "doughnut hole" (those who pay more than $3,750 a year on prescriptions but less than $5,000) will pay 25% of the cost of brand-name (35% in 2018) or 37% of the cost of generic prescriptions (44% in 2018) until they reach the catastrophic coverage level — effectively closing the "doughnut hole" for brand-name drugs. In 2020, beneficiaries in the "doughnut hole" will only pay 25% of the cost of generic drugs as well.

Please take the time now to get organized and perform a Medicare checkup before the deadline passes.



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