Don’t forget Medicare open enrollment 2019
It is open enrollment time again for Medicare beneficiaries (October 15 to December 7). This is the time of year to review your current Medicare plans such as Medigap, Medicare Advantage and Part D prescription plans. Even if you or your loved one does not make any changes, it is worth the review.
Be aware that starting in 2020, Medicare supplement plans (Medigap plans) C and F will no longer be available for new enrollees. If you currently have either of those plans, you can continue the same coverage, at least for now. Plans C and F are the most popular plans, partly because they cover the Medicare Part B deductible ($185 in 2019). Therefore, be careful in considering another Medigap plan if you currently have Plan C or F. If you are new to Medicare, or want to upgrade your Medigap plan, the closest plan to Plan C is Plan D and the closest to Plan F is Plan G. If you have traditional or original Medicare only, some type of supplement is important to cover deductibles and co-insurance for Part A (hospitalization) and Part B co-insurance (20 percent).
Medicare Advantage plans (Part C plans) are private insurance plans that function as Medigap plans by essentially replacing original Medicare. One must still be enrolled in Medicare A and B, but the Medicare Advantage plans, usually HMOs or PPOs are the beneficiary’s Medicare coverage. Many include the Part D or prescription coverage thus avoiding the need for a stand-alone Part D plan. Those with these types of plans must use “in network” physicians to avoid excessive costs, and usually pay co-payments for care. Since these are private plans, the plan administrator can change the network of doctors without warning. During open enrollment, review your current Advantage plan to see if your preferred doctors are still participating in the plan and if the formulary matches your prescription drugs. It is particularly important to determine if your regular doctors are still “in network.”
If you have a “stand-alone” prescription plan or even if your prescription plan is part of your Advantage plan, your plan’s formulary (the drugs that are covered) should be reviewed each year. If the formulary has changed, then your medications can cost you significantly more money in 2020. Pay attention to the “tiers” listed and pharmacies that are listed as “preferred.” Choosing a different prescription plan can save money over the course of the year.
Those who have Medicare and Medical Assistance need to enroll in a Community Health Choices plan for their Medical Assistance if it has not been done already. Contact your County Office of Aging for more information.
You can access several sources for assistance with Medicare questions. Contact an APPRISE counselor at your local senior center or call 1-800-783-7067 for more information. These counselors are trained volunteers that can help with Medicare questions. You can access Medicare at www.medicare. gov/find-a-plan/questions/ home.aspx or via telephone at 1-800-633-4227. Do not delay in making sure that your Medicare plans are the best for you.
The legal advice in this column is general in nature, Consult your attorney for advice to fit your particular situation.
Kathleen Martin, Esquire is licensed to practice in the Commonwealth of Pennsylvania and is certified as an Elder Law Attorney by the National Elder Law Foundation as authorized by the Pennsylvania Supreme Court. She is a principal of the law firm of O’Donnell, Weiss & Mattei, P.C., 41 High Street, Pottstown, and 347 Bridge Street, Phoenixville,610-323-2800, www. owmlaw.com. You can reach Mrs. Martin at kmartin@owmlaw.com