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2020 Medicare Open Enrollment – What you need to know

Understanding the basics of Medicare’s coverage options:

Medicare is a government-sponsored health insurance program for American citizens and permanent legal residents (of at least five years in a row) who are 65 years old or more, or who qualify by disability or certain conditions.

There are two main ways to get Medicare:

Original Medicare: Includes Medicare part A (hospital insurance) and Part B (medical insurance). If you want drug coverage, you can join a separate part D plan.

Medicare Advantage (also known as Part C): “All in one” alternative. These “bundled” plans include Part A, Part B and usually Pard D. These plans may have lower out-of-pocket costs than Original Medicare. They also may offer extra benefits that Original Medicare doesn’t cover (vision, hearing, dental etc.)

Key deadlines for enrollment in Medicare Advantage plans:

  • Fall Open Enrollment season runs from Oct. 15 to Dec. 7.
  • Medicare Advantage Open Enrollment Period runs from Jan. 1 through March 31. During this time, individuals enrolled in a Medicare Advantage Plan may make a single change, effective on the first of the following month.
  • Special Enrollment Period is open once per calendar quarter in the first three quarters of the year. It applies only to individuals enrolled in the Low-Income Subsidy (LIS), also known as Extra Help. Any changes made are effective on the first of the following month. During the fourth quarter, people with Extra Help may use the Fall Open Enrollment Period to make changes to their coverage, with changes effective Jan. 1.
  • Special Enrollment Period (SEP) for Five-Star Plans allows you to switch to a new Medicare Advantage Plan or stand-alone Part D plan that was given an overall plan performance rating of five stars for the year 2019. You may only do this once per calendar year.
  • Other Special Enrollment Periods remain, such as if you move outside your plan’s service area or if your plan goes out of business in the middle of a calendar year

 

Here are some of the abbreviations and phrases you may see:

HMO: A Health Maintenance Organization is a network or organization that provides health insurance coverage for a monthly or annual fee. An HMO is made up of a group of medical insurance providers that limit coverage to medical care provided through doctors and other providers who are under contract to the HMO.

PPO: A Preferred Provider Organization allows you to see any physician in the network, no referrals required. Most also provide some out-of-network coverage with higher co-pays. PPOs typically have the highest premiums and costs. If you want drug coverage, you must join a PPO plan that offers it.

PFFS: A Private Fee-for-Service plan makes it possible to see any doctor or provider that accepts the plan’s payment terms. Sometimes, the plan does not offer drug coverage, but you can purchase a separate drug plan to obtain coverage.

SNP: Special Needs Plans offer lower-cost options to those with limited incomes or chronic health conditions. There also are special needs plans for nursing home and assisted living residents. All plans must provide prescription drug coverage.

PDP: Prescription Drug Plans, or stand-alone plans, offer only drug coverage with no medical benefits. These plans appeal to people who want to stay on traditional Medicare, which does not cover medications.

You pay only your Part B premium: This phrase applies to plans that accept what Medicare takes out of your Social Security check as full payment. Some plans may cover part of your Part B premium, others may charge you an additional premium.

Preferred and standard pharmacies: Many plans offer better drug prices through their preferred pharmacy networks. To get the best plan deal, make a list of all the medications you take and check prices with different insurers.

Tiers: Plans put prescription drug coverage into up to six categories or tiers. Each plan can divide its tiers in different ways and each tier costs the member a different amount. Generally, a drug in a lower tier will cost you less than a drug in a higher tier.

Sun Sentinel has created a Medicare Plan Guide to help you see what plans are available in your area and to compare the key benefits each has to offer: click here

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