More than 4.5 million Floridians are on Medicare this year, the second-largest pool of recipients in the nation. So when the government tells them it’s time to review their benefits, it’s a big deal.
They have about seven weeks.
Tuesday, Oct. 15, marks the start of open enrollment, 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 time.
The election period ends Dec. 7.
While most enrollees tend to stick with the plans they know and have used before, there are some minor changes to plans this year that could affect some benefits. For the most part, though, it seems that those changes are subtle 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 Plan Finder tool on Medicare.gov, but the rollout has not been problem-free. The website got a much-needed overhaul after nearly a decade. Some online tools and interfaces may appear different this year than in previous years. Users will now be able to compare Medicare Advantage, Part D, Original Medicare and supplemental Medicare plans side-by-side.
Still, advocacy and insurance groups that help seniors sort through their coverage options have criticized the new tool. Among the complaints, according to Kaiser Health News, was that the Plan Finder “can no longer add up and sort through the prescription costs plus monthly premiums and any deductibles for all those plans. A mere human can try, but it is a cumbersome process fraught with pitfalls.”
Kaiser later reported that the problem had been corrected, but other features “may still not be functioning correctly.” State groups like Serving Health Insurance Needs of Elders, or SHINE (floridashine.org), can help beneficiaries navigate any remaining glitches.
With so many options and rules, Medicare can be a daunting system to navigate, which is where the Tampa Bay Times’ annual Medicare Guide comes in. Below and elsewhere in the guide, we break down the various parts of Medicare and offer special charts to compare plans, all to help beneficiaries choose wisely.
How Medicare works
Part A and Part B tend to be the most popular programs, and they 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 is projected to be $144.30 for most enrollees in 2020. (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 is 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, and the penalty will last as long you have Part B. 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. Everyone in Florida who qualifies for Medicare will have access to a Medicare Advantage plan that offers a zero-dollar monthly premium, but should select a plan that best fits their needs.
Enrollment in Medicare Advantage continues to rise in popularity with a projected 24 million Medicare beneficiaries for 2020, according to the Centers for Medicare & Medicaid Services. That’s a 6.2 percent increase from this past year. There are 474 Advantage plans offered in Florida this year.
More than 44 percent of Florida Medicare beneficiaries are enrolled in Advantage plans, according to Florida Blue, the state’s largest private insurer. Patients will pay copays or coinsurance for covered services, but most who enroll will have the same or lower premium in 2020. Premiums are expected to decline nationally by up to 23 percent in 2020, when compared to 2018, according to CMS. The average monthly plan premium is estimated to be around $23.
In Florida, Advantage premiums are expected to drop by 7 cents to an average of $8.38.
Medicare Advantage plans are subsidized by taxpayers. And, if you are satisfied with the doctors and hospitals in their networks, 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 last year, which will continue in 2020. The list includes perks like free transportation to and from medical appointments and the grocery store, and Meals on Wheels programs after hospital stays. Some plans even include routine visits to homebound 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. Nearly 45 million Medicare beneficiaries are enrolled in Medicare Part D plans, according to the Kaiser Family Foundation. People can buy these plans from private insurance companies for about $30 a month on average for 2020, which is down from $32.50 in 2019. The lowest monthly premium for a Part D drug plan in Florida for next year is $13.20.
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.
What kind of plan should I choose?
Some insurance companies will pay all, or part, of your Medicare Advantage premium. Some plans offer vision, hearing and dental benefits that Original Medicare does not, though sometimes these benefits are minimal.
The tradeoff 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 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 the 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.
About the gap
Last year, beneficiaries who enrolled in Medicare Part D and reached the Medicare Coverage Gap received new savings when filling brand-name medications. That change continues into 2020, when those savings will be extended to generic drugs as well.
The gap, also known as the “donut hole,” originally was created as an incentive for seniors to help keep prescription costs down by asking for generic drugs. But the strategy proved to be a hardship for many who rely on brand-name options. Now Medicare is making the gap more friendly by requiring drug manufacturers to offer discounts.
Consumers reach the donut hole when the total cost of their drugs for the year, including deductibles and copays, reaches a certain amount. In the past, they had to pay all their drug expenses once they hit that amount — until they reached 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, consumers in the donut hole will have to pay only 25 percent of prescription drug costs, whether they’re buying generic or brand-name drugs. (This year, those consumers had to pay 37 percent of the cost for generic drugs.)
In 2020, the donut hole begins when the total cost of a person’s drugs for the year reaches $4,020. It ends when the cost hits $6,350.
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 — called QI, QMB and SLMB — for low-income people. The lower your income, the more you stand to gain.
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 has 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 the SHINE volunteers do.