It’s registration time for older adults looking to find a Medicare prescription drug or managed-care plan for 2020.
Open enrollment is in progress for older and disabled adults who want to shop for the Medicare Advantage managed-care plans and Medicare Part D prescription drug plans. They are available for everyone covered by Medicare, the federal health insurance program for people 65 or older, plus some younger disabled Americans.
Enrollment continues through Dec. 7. Changes are effective Jan. 1.
Whether this is your first year shopping for a plan or you’re a pro, it’s important to review your plan, since plan offerings change every year, said Chris Reeg, director of the Ohio Department of Insurance’s Senior Health Insurance Information Program.
“Just because it was the best plan in 2019, it may or may not be the best plan in 2020,” Reeg said. Insurers have a one-year contract with Medicare, and every year, the pricing structure can change, including premiums, drug costs and the provider directory, she said.
Take a close look at the costs of services you use most, said Francine Chuchanis, director of entitlement rights for Direction Home, an aging agency in the Akron and Canton area.
“If you’re a person who goes to a lot of specialists, you want to see what it’s going to cost you,” said Chuchanis. Also look at copays, deductibles, drug formularies and provider quality star ratings, she said.
Look beyond price
However, Chuchanis and Reeg warn against simply choosing the cheapest plans without looking at other factors. And unlike the adage of “you get what you pay for,” there are many zero-premium Medicare Advantage plans with good coverage because Medicare pays plans to participate and subsidizes some costs, they said.
People shouldn’t jump into new Medicare Advantage plans, said Andy Haggard, Medicare outreach manager of the Central Ohio Area Agency on Aging.
“I just caution people … be very careful if you find something else that you want, that you … [check] with your providers first to make sure that they are in-network before you make any changes,” he said.
If you’re interested in staying with your same plan, your insurer should have mailed a letter outlining changes. If you want to stay on the same plan for next year, you will get automatically renewed, but it’s not a bad idea to call to confirm, Chuchanis said.
Medicare.gov got a major overhaul this year, the first in 10 years. There have been some glitches.
Reeg said, “We always caution folks when Medicare is making updates, we’ll run [the information] and that information is as accurate as we can test it, but if there are discrepancies, contact the company directly.”
This year, a requirement that insurers have substantial differences among their various plans was eliminated, so there are more plans, but they might look quite similar, Chuchanis said.
“People will have to pay very close attention to subtle differences between plans,” she said. “It could be the difference between a $5 copay for a primary care doctor visit and a $10 copay.”
Often, various plans’ overall costs may be the same in the end, but consumers need to find what’s best for them and their finances — perhaps a small monthly premium is more important than a high deductible, Chuchanis said. People with high medical costs should also pay attention to out-of-pocket maximums.
While many Medicare Advantage plans offer extra benefits for dental, vision and hearing, plans this year can expand their supplemental benefits. That includes home and bath safety devices, emergency response devices, telehealth and short-term meals — even pest control services for chronic illnesses.
“Please don’t pick your health and prescription benefits based on those extra benefits,” cautions Reeg. “Put your health and medical needs first. If there’s icing on that cake, have at it.”
For instance, some seniors have wanted to change a plan solely for the SilverSneakers program, which offers free membership at participating gyms. Reeg said once they looked at their drug coverage, however, they’d be spending thousands more on drugs.
It's an individual thing
Similarly, spouses need to review their plans individually and often have to pick different plans, Reeg said.
The Medicare Part D drug plans are offered statewide; the Medicare Advantage plans vary by county.
The federal government contracts with private insurance companies to provide drug and/or medical coverage to Medicare recipients who sign up for the plans. Everyone but the poorest enrollees pays a portion of the monthly premium; the government picks up the rest.
Nationally, Medicare Advantage continues to be popular, with enrollment projected to increase to an all-time high of 24.4 million beneficiaries from the current enrollment of 22.2 million, according to the Centers for Medicare and Medicaid Services. That’s out of approximately 60 million people currently enrolled in Medicare. Enrollment in Medicare Advantage in 2020 is expected to have increased by 30.6% since 2017.
Medicare Advantage average monthly premiums are expected to decrease 14% to $23 in 2020 from an average of $26.87 in 2019.
In Franklin County, there are 45 Medicare Advantage managed-care plans, and 33 of those have a 4-star or higher rating.
Consumers should use Medicare’s quality star ratings. The ratings help people with Medicare, their families and their caregivers compare the quality of health and drug plans being offered. Managed-care and drug plans are given a rating on a 1 to 5 star scale, with 1 star representing poor performance and 5 stars representing excellent performance.