Medicare Open Enrollment Q&A with the
National Council on Aging
Medicare’s Annual Open Enrollment Period began on October 15th and runs through December 7th. This is an opportunity for people with Medicare to explore their options for picking or changing Medicare health (Medicare Advantage) or prescription drug (Part D) plans. If you need a refresher on the different parts of Medicare and what they cover, visit MyMedicareMatters.org.
We’ve partnered with the National Council on Aging (NCOA) to answer your questions about what to do during this time and how you can save money on your Medicare costs.
1. What changes can I make during the Annual Open Enrollment Period?
Anyone enrolled in Medicare (Parts A & B), including those who may already be enrolled in a Medicare Advantage or Part D plan, can use the Annual Open Enrollment Period to:
» Change from Original Medicare to a private Medicare Advantage plan
» Change from Medicare Advantage to Original Medicare
» Join, drop or switch Part D drug plans
» Switch Medicare Advantage plans
2. Why should I re-evaluate my plan during Open Enrollment?
People change, and so do plans. Even if you think you’re in a plan that suits your needs, it’s a good idea to check and make sure it will continue to offer the services you use and cover your prescription medications in the new year.
As you evaluate your coverage, you will want to pay attention to the 4 Cs—cost, coverage, convenience, and customer service. Learn more about specific questions you should ask yourself and your plan.
3. What about Medigap/supplemental insurance? Can I switch or join those plans too?
Since Medigap plans are designed to be long-term supplemental insurance, there is no annual enrollment opportunity to shop for these plans. Once you enroll in a Medigap plan, you generally keep it for life, unless you choose to leave Original Medicare with Medigap and get a Medicare Advantage plan instead. (You cannot have both a Medigap and Medicare Advantage health plan.)
In general, the best time to buy a Medigap policy is during your 6-month Medigap open enrollment period when you first join Part B. During this time, you can buy any Medigap policy sold in your state, even if you have health problems. Later, you may not be able to buy a Medigap policy or it may cost more if you have a pre-existing condition.
Check with your state's department of insurance for the specific rules around Medigap in your area.
4. I take an expensive drug. This year I fell into the donut hole. How can I save on the out-of-pocket costs for my medicine with Medicare and avoid it next year?
Many people with Medicare who take expensive medications fall into the donut hole, which is another term for the Part D coverage gap. The coverage gap occurs when a person reaches a certain spending limit for their drugs ($3,820 in 2018) and must pay more of the costs of their medications after crossing that threshold.
The Annual Open Enrollment Period is the best opportunity to shop around to see what you might pay for your drugs under different plans, and possibly avoid falling into the donut hole. You should also explore whether you qualify for any money-saving programs, such as Part D Extra Help, Patient Assistance Programs from drug manufacturers or State Pharmaceutical Assistance Programs.
5. What should I know about the maximum out-of-pocket limits for Medicare plans?
All Medicare Advantage plans have a maximum out-of-pocket (MOOP) limit, which is the total amount you can spend on co-pays and coinsurance for covered or eligible medical services in any given year. Once you reach this limit, you have no more co-pays for Parts A and B services. The MOOP limits vary depending on the type of plan, but in 2019 the maximum will be $6,700. The amount you pay for most prescriptions obtained from retail or mail order pharmacies does not apply to the MOOP.Prescription drug costs have a separate out-of-pocket maximum.
6. Where can I get help choosing or changing a Medicare plan?
The Medicare.gov official website has tools that let you compare coverage options and enroll in a plan should you choose to do so. You can also call the 1-800-MEDICARE call center, which is open every day, 24/7 during Open Enrollment, except for Thanksgiving.
Every state has a State Health Insurance Assistance Program (SHIP) providing free, objective assistance to people with Medicare and their families. To find your local SHIP, call toll-free 877-839-2675 or visit the SHIP TA Center website.
Finally, NCOA offers an online Medicare questionnaire at its education site, My Medicare Matters®, to help you figure out your options. You’ll be able to talk to a free licensed benefits advisor to discuss changing Medicare plans and discuss any other questions you may have about Medicare.
7. When is the last day to make changes to my plan?
You can make changes to your plan through December 7. If you miss your opportunity, there may still be other chances to switch coverage before the next annual enrollment period. Specifically:
» If you are enrolled in a Medicare Advantage plan, there is an opportunity between January 1 and March 31 called the Medicare Advantage Open Enrollment Period to switch plans or return to Original Medicare and pick up a prescription drug plan.
» Several Special Enrollment Periods allow you to change plans if you move, lose other coverage, qualify for Extra Help with prescription drug costs, or encounter other special circumstances.
But don’t wait until the last minute—the best time to start evaluating your options is now!