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Medicare open enrollment: what you need to know

The seven-week period gives beneficiaries a chance to change their coverage for 2021. Insurers work to make the process safe during the pandemic.

More than 4.6 million Florida residents receive health coverage through Medicare, and the time to review their benefits is here.

The process will look a bit different this year because of the coronavirus pandemic. Enrollment often happens face-to-face, at crowded events and inside offices where beneficiaries can ask questions and get help.

This year, though, those interactions are mostly happening online and over the phone. Insurance companies have trained staffers on new processes and say they’re geared up for the start of open enrollment on Thursday, Oct. 15.

Then through Dec. 7, people covered by Medicare, the federal insurance program designed for those 65 and older, can evaluate their options and decide whether to make changes.

Beneficiaries can use this time to 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.

Two new Medicare Advantage plans are being offered locally by BayCare Health System, the nonprofit hospital chain, which started offering insurance in 2019. BayCare has gained about 8,000 members since, and that’s expected to grow to about 12,000 in 2021, said Larry J. Costello, president of BayCare Health Plans.

One of the new plans is offered only in Pinellas County and the other is available in Hillsborough, Pasco and Polk counties.

Like other providers, BayCare says it is ready to be flexible to meet beneficiaries' needs, whether they want to meet in person with masks or enroll over the phone or computer, Costello said. Representatives will do home visits with protective gear if that’s what a member prefers.

“However they want to do it, that’s how we’re going to do it,” he added. “We really have put all the options on the table."

How Medicare works

The most popular programs are Part A and Part B. They offer the most free services for those who qualify.

Part A covers inpatient hospital care, nursing home care, hospice and at-home care. The services are usually free, meaning there’s no premium to pay.

Part B covers outpatient hospital care, doctor bills, physical therapy and more. It is optional and costs most people a monthly premium, which is projected to be $144.60 for most enrollees in 2021. The cost can be higher for some, depending on income. It can also be lower for those who have the premium deducted from their Social Security check.

It’s wise to sign up for Part B when you first become eligible for Medicare, even if you’re healthy, unless you are still on an employer’s health plan. If you don’t, your monthly premium could go up by 10 percent for each year you could have had Part B but didn’t sign up. This applies to those with both Original Medicare and Medicare Advantage plans.

Medicare Advantage plans are known as Part C. They are managed by private insurance companies through either an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization). They offer bundles that include Part A, Part B and usually the Part D prescription drug program. Monthly premiums for 2021 are projected to be between $0 and $145.50.

Medicare Advantage enrollees often must choose their doctors from a plan’s predetermined list of providers. But there’s a limit on out-of-pocket expenses each year, and these plans are known to carry extra benefits, like vision, hearing, dental and more, that Original Medicare does not.

More and more people have opted for Medicare Advantage plans in recent years. This past year saw a 6 percent increase in enrollees. More are projected to enroll for 2021, according to the Centers for Medicare & Medicaid Services, a federal agency known as CMS.

About 42 percent, or 26.9 million, of beneficiaries across the U.S. are expected to choose Medicare Advantage plans, the agency says.

In Tampa Bay, nearly 50 Medicare Advantage plans are available in 2021.

This enrollment cycle will be the first time that those with end-stage renal disease, or kidney failure, can choose a Medicare Advantage plan rather than Original Medicare. And new perks are popping up in plans across the board, said Kathy Feeny, president of Florida Blue Medicare.

Like BayCare, Florida Blue has plans that offer meal delivery. But it also has partnered with Zipongo, a digital nutrition platform that members can access, to learn how to make better choices about what they eat.

Feeny said she expects people to continue moving toward Medicare Advantage plans, especially because of the pandemic.

“With the stock market the way it’s been and how 401ks have been hurt, income has gone down, so people are looking at how they can still afford their health care,” she said. “Overall, Medicare Advantage plans cost less, so people are going to make the switch.”

Florida Blue’s zero-dollar exclusive provider plan, which requires beneficiaries to get health care services from certain doctors and hospitals, is the fastest-growing plan in the state, Feeny said. Florida Blue has increased its staff to meet the demand, making sure safety protocols are in place for enrollment.

At the same time, the number of Medicare Advantage plans has tripled since 2017. The average number per county will increase from about 39 plans in 2020 to 47 plans in 2021, according to CMS.

“The benefits are getting better,” said Deb Galloway, president of Humana in north and central Florida. “There’s more competition and there’s much more access to getting information."

Several of Humana’s plans for 2021, including all of those offered in Tampa Bay, have expanded transportation benefits, for example. The service is one piece of the company’s Social Determinants of Health Value-Based Program, created for members experiencing food insecurity, social isolation, loneliness and housing instability.

With it comes $500 a year that a care manager will help a member use to address environmental or situational barriers to their health, Galloway said. A beneficiary might use it to install a support bar in their bathroom, or to pay for transportation services that aren’t already covered by their plan.

Galloway pointed out that those with a Medicare Advantage plan have a grace period of sorts to change their benefits past the close of open enrollment. They can switch between plans from Jan. 1 through March 31, giving them more flexibility than Original Medicare.

The average monthly premium for Medicare Advantage plans is expected to decrease by 11 percent, to $21, in 2021, the lowest it’s been since 2007, according to CMS.

As for prescription drugs, more than 47 million people are enrolled in Medicare Part D plans, the agency says.

The average monthly cost is $30.50 for 2021, down 12 percent since 2017. Enrollment in Part D has increased by 16.7 percent in that same period.

Unless you already have prescription drug coverage through an employer, a union or the Department of Veterans Affairs, it’s important to get it when you pick a plan. It’s accessible through either a Part D drug plan if you are on Original Medicare or through a Medicare Advantage plan that covers drugs.

It’s smart to secure drug coverage even if you don’t currently use any prescription medications. You could get sick and need expensive drugs. Plus, if you decline the coverage now and try to sign up later, the cost will go up for each year you didn’t have it.

What kind of plan should I choose?

Medicare Advantage is often less expensive than Original Medicare, and some plans offer additional benefits that Original Medicare does not. But there’s a lot less flexibility when picking providers.

With Original Medicare, you can pick any doctor or hospital in the country where Medicare is accepted. Advantage plans tie you to a network and you have to pay a fee if you get services outside it.

Beneficiaries who want to continue seeing a certain doctor, going to a certain hospital or taking a certain drug should make sure they are on an Advantage plan that covers them. Plans can and do change from year to year.

It’s important to review your options in detail. The plan with the cheapest premium isn’t always best, as it could provide less coverage for important services, like hospital visits.

The gap

Part D comes with a catch called the “donut hole" that could cause some enrollees to pay more for prescription drugs.

Medicare beneficiaries reach the donut hole once they spend a certain amount of money on medications for the year, causing insurance providers to stop covering as much of the cost of their prescriptions. They exit the donut hole once they reach the out-of-pocket threshold that causes drug prices to drop.

The donut hole begins at a slightly higher amount for 2021 than this year, up $110 to $4,130. The out-of-pocket threshold starts at $6,550, up $200 from this year.

Not all beneficiaries will reach the donut hole. Those who do will pay 25 percent of both generic and brand-name prescription drug costs while in it, just as enrollees did this year.

Comparing costs

Costs vary depending on the services and drugs you use. The best way to find which plan is best for you and your particular situation is to use Medicare’s online Plan Finder, which allows you to factor in your health conditions and the medications you take.

Extra help

Those with limited income and resources can apply for Medicare’s Extra Help program, which reduces out-of-pocket costs for drug coverage so long as the person is enrolled in Part A and Part B.

To qualify, a person’s combined savings, investments and real estate must not exceed $29,160, if they are married and living with a spouse. The threshold is $14,610 for singles and those who are not living with their spouse.

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 — that help low-income people pay their premiums. Each program has different parameters but, generally, the lower your income, the more help you will likely get.

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.

Still confused?

Florida’s SHINE program has volunteers who are experts in Medicare and can help you find the plan that is best for you. The letters stand for Serving Health Insurance Needs of Elders, and the free service is 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.

You can also get help directly 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. Also, SHINE volunteers have no bias toward any particular plan.

It’s important to have a list of all your doctors, medications, dosages and monthly usage before contacting SHINE.

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