Medicare enrollees have a flood of options to choose during open enrollment, which starts today, and this year the privatized plans will come with three months to “test drive” the option.
Nearly 2.3 million people in Ohio — including around 160,000 in the Dayton metro area — are eligible for the federal health insurance program and will need to decide by Dec. 7 whether to enroll in traditional Medicare or one of the many privatized options, known as Medicare Advantage plans.
This season, Medicare enrollees who choose a Medicare Advantage plan will also have from Jan. 1 to March 31 to change their mind and switch to another plan.
Overwhelmed? The state gives free one-on-one help through the Ohio Senior Health Insurance Information Program at 1-800-686-1578, which can help review coverage options. The plan that worked last year might not be the best option this year. The plan that works for one spouse might not be the best option for the other.
“Medicare open enrollment is the time that everyone on Medicare should review their health care and prescription drug plan to see if they need to make a change,” said Chris Reeg, program director for Ohio Senior Health Insurance Program.
Reeg said people should review what the cost of a plan is, whether it provides the medical and prescription coverage they need and how convenient the plan is to use.
Seniors should keep an eye out for a letter from their insurance plan which will detail any changes coming next year to their current Medicare plan, Reeg said.
About 66 percent of Ohioans get traditional Medicare, typically also with supplemental coverage. The other 34 percent have Medicare Advantage, which is a Medicare plan privately managed by a commercial insurance company.
Original Medicare is accepted almost everywhere and enrollees don’t have to worry about a network. Medicare Advantage plans have limited networks and those networks can change during the year after enrollment is closed.
On the other hand, Medicare Advantage plans tend to be less expensive and can come with additional benefits like dental and vision. Next year will be the first year that private Medicare plans can opt to pay for non-clinical benefits like adult day care and caregiver support services. The privatized Medicare plans also cap out-of-pocket expenses once enrollees have paid out to a certain limit set by the plan.
Don Mackos, president of Miamisburg-based Retired MediQ, which brokers Medicare plans, said in past years, open enrollment has been marked by disruptions like plans dropping physicians from their networks, but this year he’s mostly seen improvements in Medicare Advantage plans.
There’s more competition entering the area and prices are holding steady. Nearly 83 percent of Medicare Advantage enrollees remaining in their current plan will have the same or lower premium in 2019, according to U.S. Centers for Medicare & Medicaid Services.
“Most of the changes we see with Medicare Advantage this year are improvements,” Mackos said.
He said the option for Medicare Advantage enrollees to make a change the first three months of this year will benefit customers and pressure insurance companies to provide good service and a good product or lose business.
“If, for whatever reason, you are on a Medicare Advantage plan and you want to make a change, you could just one time or go back to original Medicare,” Mackos said.
Another upcoming change is the early closing of part of the Part D coverage gap, sometimes called the “doughnut hole.” It’s a coverage hole where enrollees pay more for prescriptions after they reach a certain threshold until they pay enough to reach a second threshold, after which costs go substantially back down. The doughnut hold for brand name drugs closes in March and for generic drugs in 2020.
Medicare enrollment season also tends to draw out scammers, so people should be aware of phone scams and other kinds of fraud. Any concerns about fraud can be reported directly to Medicare at 1-800-633-4227.
While enrollees might get advertisements in the mail, no one should be calling or knocking on doors and saying they are with Medicare or asking for any kind of payment. No one should be asking by phone for Medicare card information or social security numbers.
The only contact seniors should get will be from someone calling them back or contacting them about a scheduled appointment.