For the nearly 4.4 million Floridians who receive benefits through Medicare, this is an important time of year.
Monday, Oct. 15, marks the start of the Annual Election Period, when people covered under the federal health insurance program for those 65 and older get a chance to evaluate their options and decide whether to make a change.
They can switch from Original Medicare to a Medicare Advantage plan, which offers an alternative way to receive Medicare benefits through a private insurance company. Or they can do the reverse and return to Original Medicare. They also can switch Medicare Advantage plans, or change prescription drug plans, known as Part D. Plus, those who did not enroll in Part D when they were first eligible can do so during this period.
The period ends Dec. 7.
But for the first time in years, enrollees will have a second chance to modify their plans. From Jan. 1 to March 31, consumers can opt to switch to a different Medicare Advantage plan or revert to Original Medicare, known as Part A and Part B, if they're unhappy with the plan they selected.
While most enrollees tend to stick with the plans they know and have used before, there are some subtle changes to plans this year that could affect some benefits. For the most part, though, it seems that those changes are slight ones — with some reduced and rising premiums and some expanded coverage.
Patients should always double-check their plans, even if they choose to remain with an existing one, as even minor changes could mean some doctors may no longer be part of the network, or specific prescription medication may become more expensive or not be covered at all.
The biggest change this year is the new Medicare identification cards, which were revised to remove Social Security numbers to prevent fraud and identity theft. The government started mailing them out in April and will continue through April 2019.
The array of options available to Medicare recipients can seem mind-boggling. With that in mind, the Tampa Bay Times' annual Medicare Guide aims to help beneficiaries choose wisely.
How Medicare works
Part A and Part B tend to be the most popular programs, which generally offer the most free services for consumers who qualify.
• Part A covers inpatient hospital care, nursing home care, hospice and a few other services like at-home care. These services are usually free, which means there's no premium to pay.
• Part B covers outpatient hospital care, doctor bills, physical therapy and more services. Part B is optional and costs most people a monthly premium, which will be $135.50 for most enrollees in 2019. (The premium is higher for some, depending on income, and a little lower for those who have it deducted from a Social Security check.)
It's advisable to sign up for Part B when you first become eligible for Medicare, no matter how healthy you are — unless you are still working and included on an employer's health plan. Otherwise, you will face a stiff penalty when you do need this coverage. Even if you choose a private Medicare Advantage plan for your coverage, you have to sign up for Part B.
• Medicare Advantage plans are known as Part C. This is privately managed care — usually an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) — in which you often must choose your medical providers from a plan's predetermined list.
Enrollment in Medicare Advantage is projected to be at an all-time high in 2019 with 22.6 million Medicare beneficiaries, according to the Centers for Medicare & Medicaid Services. That's a projected 2.4 million increase from last year. In Florida, there are 391 Advantage plans available.
Insurers in Florida say the majority of their Medicare enrollees opt for Advantage plans. You will pay copays or coinsurance for covered services.
Medicare Advantage plans are subsidized by taxpayers. And, if you are satisfied with the doctors and hospitals in their network, they usually turn out to be less expensive than Original Medicare, though not always. Most Advantage plans also provide drug coverage, so you do not need a separate Part D drug plan.
The Centers for Medicare & Medicaid Services approved a range of new benefits for Advantage plans this year. The list includes perks like free transportation to and from medical appointments and the grocery store, or Meals on Wheels programs for after hospital stays. Some plans even include routine visits to home-bound patients to avoid isolation.
It's worth noting that Part A and Part B services under Original Medicare come with deductibles and copays, too. Many people cover these costs by buying private Medicare supplement policies, also known as Medigap. This is not required and premiums tend to be high, but if you suffer a catastrophic illness, Medicare supplement policies will pay off.
Also, a few Medicare supplement policies offer coverage outside the country, which Original Medicare does not. People who travel abroad might consider one of these plans.
• Part D covers prescription drugs. More than 42 million Medicare beneficiaries are enrolled in Medicare Part D plans, according to the Kaiser Family Foundation. You buy these plans from private insurance companies for $32.50 on average in 2019, which is down from $33.59 this year. The plan then defrays the cost of your medications. These plans have deductibles and copayments but are subsidized by taxpayers and usually a good deal.
How do I get a Medicare Advantage plan?
There is some good news about Medicare Advantage plans this year. The Centers for Medicare & Medicaid Services says more than 80 percent of Medicare Advantage enrollees will have the same or lower premium in 2019 if they continue in the same plan. Premiums are expected to decrease to $28 on average, compared to $29.81 last year.
Some insurance companies will pay all, or part, of your premium. Some plans offer vision, hearing and dental benefits that Original Medicare does not, though sometimes these benefits are minimal.
The trade-off is that Original Medicare lets you pick any doctor or hospital in the country, whereas Advantage plans often restrict you to a network — or they charge a hefty fee if you get service outside the network. If access to a particular hospital or doctor is important to you, make sure they are on the Advantage plan you are considering.
Also, plans can and do drop providers from their networks. Advantage plans always carry a risk that you can end up losing the doctor you want to see. Worse, some Advantage plans have gone bankrupt or have been shut down by authorities midyear, sending you and thousands of others scrambling for new doctors. If that happens, Medicare will give you a chance to find a new plan.
What's more, some Advantage plans skimp on coverage for hospital visits, skilled nursing care or other services. Pay close attention to the benefits offered when picking a plan. Don't just choose one because it has the cheapest premium.
Unless you already have prescription drug coverage through the Department of Veterans Affairs, the union you belong to, an employer or through some other source, it's important to get some kind of drug coverage — either a Part D drug plan if you are on Original Medicare or a Medicare Advantage plan that covers drugs.
You should get coverage even if you don't use any prescription drugs.
Many Advantage plans offer drug coverage without any extra charge. If you get sick and need expensive drugs, you will be happy you bought coverage. More important, if you decline drug coverage now, the government will impose a stiff penalty every year if you try to sign up later.
Your costs could vary widely depending on the drugs you take and services you use.
The best way to compare costs tailored to your circumstances is with Medicare's online Plan Finder, which allows you to factor in your health conditions and the drugs you take.
Mind the gap
This year, beneficiaries who enroll in Medicare Part D will no longer be exposed to the long-standing coverage gap, or "donut hole," when filling brand-name medications.
The change is being instituted as the government phases out the gap by requiring drug manufacturers to offer discounts on the price of brand-name drugs.
The donut hole originally was created to encourage seniors to play a role in keeping drug costs down by encouraging them to ask for generic drugs. But the strategy has proven to be a hardship for many who rely on brand-name options.
Consumers reach the donut hole when the total cost of their drugs for the year, including deductibles and copays, reaches a certain amount. After that, they pay all their drug expenses until they reach a larger amount that brings them to the end of the donut hole. From there, they are entitled to "catastrophic" coverage with much lower costs for the rest of the year.
Under the new rules starting in 2019, consumers who reach the donut hole will have to pay only 25 percent of brand-name prescription drug costs compared to 35 percent this year.
The donut hole for generic drugs is expected to be phased out in 2020.
Medicare's Extra Help program, for people with limited income and resources, can reduce out-of-pocket costs for a Part D drug plan or a Medicare Advantage plan that covers drugs.
To qualify, a person must not have combined savings, investments and real estate that are worth more than $27,600, if married and living with a spouse. An individual must not have a net worth of more than $13,820 if unmarried. Applicants must already be enrolled in Medicare Part A or Part B.
If you think you qualify, contact the Social Security Administration toll-free at 1-800-772-1213 or apply online at socialsecurity.gov.
The federal government also offers Medicare Savings Programs for low-income people. The lower your income, the more you stand to gain.
For all these programs — called QI, QMB and SLMB — your liquid assets cannot exceed $7,280 for a single person or $10,930 for a married couple. (Liquid assets include stocks, cash and savings accounts. They do not include your home or car.)
Note: To see if you qualify or to find out how to apply, call Florida's Medicaid office toll-free at 1-866-762-2237, apply online at socialsecurity.gov/i1020 or call Social Security toll-free at 1-800-772-1213. Ask for information about Medicare Savings Programs.
Florida's SHINE program is made up of volunteers who can navigate Medicare's website and help find the plan best suited to you. The letters stand for Serving Health Insurance Needs of Elders; it's a free program offered by the Florida Department of Elder Affairs and the local Area Agency on Aging. Call them toll-free at 1-800-963-5337 or visit floridashine.org.
Important: Before you contact SHINE, make a list of all your drugs, dosages and monthly usage.
Note: You also can get help from Medicare by calling toll-free 1-800-633-4227, but the government workers there generally have less time to spend with you than SHINE volunteers do.
Contact Justine Griffin at firstname.lastname@example.org or (727) 893-8467. Follow @SunBizGriffin.