What you need to know about Medi­care en­roll­ment

Orlando Sentinel - - OPINION - By Janet Trautwein

Medi­care’s An­nual Election Pe­riod is al­most here. Be­gin­ning Oct. 15, se­niors will be able to choose their Medi­care plans for 2019. They'll have to make their se­lec­tions by Dec. 7 for cov­er­age that takes ef­fect Jan. 1.

The en­roll­ment process will be a lit­tle dif­fer­ent than pre­vi­ous years. This time around, se­niors will have the chance to "test-drive" plans at the be­gin­ning of the year — and se­lect a dif­fer­ent plan if they dis­cover that their ini­tial choice doesn't meet their bud­getary or health­care needs.

That flex­i­bil­ity is wel­come — and will en­sure that Medi­care meets the health-care needs of its mil­lions of ben­e­fi­cia­ries bet­ter than ever be­fore.

Medi­care cov­ers about 60 mil­lion Amer­i­cans. Se­niors be­come el­i­gi­ble for all four of the pro­gram's com­po­nents — Parts A, B, C, and D — when they turn 65.

Part A pays for hospi­tal stays. Part B cov­ers doc­tor vis­its, same-day surg­eries, and po­tent med­i­ca­tions ad­min­is­tered in physi­cians' of­fices. Part D is Medi­care's op­tional pre­scrip­tion drug ben­e­fit.

Part C, also known as Medi­care Ad­van­tage is ad­min­is­tered by pri­vate in­surance car­ri­ers and places a cap on the out-of­pocket ex­penses not avail­able on Parts A and B of Orig­i­nal Medi­care. Part C typ­i­cally in­cludes the pre­scrip­tion drug ben­e­fit at no ad­di­tional cost. There are other ex­tra ben­e­fits that save money and ap­peal to a con­sumer liv­ing a healthy life.

Cur­rently, more than 20 mil­lion Amer­i­cans are en­rolled in more than 2,300 dif­fer­ent Medi­care Ad­van­tage plans, each with its own mix of ben­e­fits, monthly pre­mi­ums, co­pays, out-of-pocket spend­ing, and more.

With all these op­tions, de­cid­ing on a plan can be tricky. Ben­e­fi­cia­ries and their fam­i­lies must con­sider myr­iad life­style fac­tors, how much they can af­ford to spend, and what their fu­ture health needs may be.

In re­cent years, Congress didn't make those de­ci­sions any eas­ier. Since 2011, se­niors who chose a Medi­care Ad­van­tage plan have had 45 days to "dis­en­roll" if they de­ter­mined that it wasn't the right fit for them. But they couldn't switch to an­other Medi­care Ad­van­tage plan — their only al­ter­na­tive was en­rolling in tra­di­tional Medi­care.

Of course, tra­di­tional Medi­care prob­a­bly wasn't right for them, ei­ther. Oth­er­wise, they would've cho­sen it in the first place. So they were stuck for the re­main­der of the year with two subop­ti­mal op­tions for cov­er­age.

Thank­fully, that won't be the case any­more. Start­ing next year, ben­e­fi­cia­ries who

HOME DE­LIV­ERY RATES en­roll in a Medi­care Ad­van­tage plan will have the abil­ity to switch to an­other Ad­van­tage plan at any point within the first three months of 2019.

That's twice as long as they had to eval­u­ate their plans un­der the pre­vi­ous set of rules.

The change also gives se­niors much more flex­i­bil­ity — and can make open en­roll­ment less stress­ful. If they con­clude that they picked the wrong plan ini­tially, they won't be pe­nal­ized. They'll have a full ar­ray of other Medi­care Ad­van­tage plans to choose from. Tra­di­tional Medi­care won't be their only fall­back op­tion.

Se­niors may find all these op­tions em­pow­er­ing — and over­whelm­ing. For­tu­nately, help is avail­able.

Medi­care.gov con­tains a wealth of in­for­ma­tion that can of­fer as­sis­tance to ben­e­fi­cia­ries fil­ter­ing through their op­tions.

Se­niors can con­sult li­censed health in­surance agents and bro­kers. Many of these pro­fes­sion­als have decades of ex­pe­ri­ence in the field and are spe­cially trained to ed­u­cate con­sumers about their in­surance op­tions. Ac­cord­ing to re­search from the Kaiser Fam­ily Foun­da­tion, nearly three­quar­ters of agents and bro­kers spend a sig­nif­i­cant por­tion of their time ex­plain­ing cov­er­age to clients and in­ves­ti­gat­ing con­sumer in­surance op­tions.

Agents and bro­kers can help se­niors de­ter­mine which Medi­care Ad­van­tage plan would be best for them — or whether they'd be bet­ter off en­rolling in tra­di­tional Medi­care.

Those who live in a FEMA-de­clared dis­as­ter area dur­ing the An­nual Election Pe­riod may qual­ify for a Spe­cial Election Pe­riod out­side of the nor­mal Oct. 15 to Dec. 7 en­roll­ment win­dow. So se­niors un­able to en­roll due to FEMA de­clared dis­as­ters such as fire, vol­cano, hur­ri­cane, and more can ask an in­surance pro­fes­sional if a Spe­cial Election Pe­riod has been an­nounced.

Medi­care cov­ers nearly one in five Amer­i­cans. This open en­roll­ment sea­son, that size­able pop­u­la­tion will find that they have more choices — and more flex­i­bil­ity — than they have in pre­vi­ous years. Savvy se­niors should take ad­van­tage.


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