October 4, 2018 / 10:01 AM / 2 months ago

COLUMN-Fall season means it is time to tune up your Medicare coverage

 (The opinions expressed here are those of the author, a
columnist for Reuters.)
    By Mark Miller
    CHICAGO, Oct 4 (Reuters) - If you are not happy with your
Medicare coverage, now is the time to make a change.
    The annual Medicare fall enrollment period for 2019 begins
on Oct. 15 and runs through Dec. 7. This is the time of year
when you can make changes to your basic coverage and to your
prescription drug insurance. Fall enrollment presents an
opportunity to save money - but even more important, the chance
to make sure your insurance coverage provides the best match of
healthcare providers.
    The basic choice is between traditional fee-for-service
Medicare and a Medicare Advantage plan, the all-in-one
managed-care alternative offered by private insurance companies.
Advantage plans usually include prescription-drug coverage, and
cap out-of-pocket expenses. 
    Advantage can save you money in some instances, but the
tradeoff is being tied to a narrower network of healthcare
providers. Traditional Medicare still provides the widest, most
flexible access to providers. Seniors who choose traditional
Medicare usually add a standalone Part D drug plan; many also
add a Medigap supplemental policy. 
    Even if you like your current coverage, it can pay to take a
careful look. The design of your prescription drug plan coverage
can change annually, and Advantage plans can make changes to
their networks of healthcare providers at any time.
    The shopping process should begin with a review of a letter
that arrives each autumn from your Medicare prescription drug or
Advantage plan provider. Called the Annual Notice of Change
(ANOC), this letter details any changes in rules for
cost-sharing, coverage of specific medications - and even
whether a specific drug will be covered.
    “The ANOC gives the simplest overview of what is changing in
the plan you currently have for next year,” said Casey Schwarz,
senior counsel, education and federal policy, at the Medicare
Rights Center.
    Pay careful attention to the network of providers in your
current plan for the coming year - pharmacy delivery options in
the case of standalone drug plans, and healthcare providers if
you have an Advantage plan. Also read carefully the so-called
formulary, which describes the rules for coverage of a
medication, including whether any quantity limits are imposed,
or if the red tape of “prior authorization” will be invoked.
    
    NEW THIS YEAR IN MEDICARE ADVANTAGE
    Advantage plans provide all-in-one coverage of
hospitalization and outpatient services, sometimes for the same
monthly premium you pay for traditional Medicare ($134 this
year). Most plans offer extra benefits such as dental and vision
coverage; many also wrap in prescription drugs. Just over half
of plans (55 percent) will charge a supplemental premium for
those extras, averaging $34 next year, according to the Kaiser
Family Foundation (KFF).
    For next year, the Centers for Medicare & Medicaid Services
(CMS) have given insurers the option to add new services such as
adult daycare and home-based palliative care or home health
aids. Equipment that helps frail seniors stay in their homes
also can be covered, including grab bars and stair rails. 
    But few plans will offer the expanded services for 2019,
since CMS just announced the new rules in April, according to
Gretchen Jacobson, associate director of the KFF Medicare
program. “Plan providers didn’t have much time this year to
incorporate these new services,” she said. “We could see more
plans offering them in 2020.” (None of the new benefits will be
available to enrollees in traditional fee-for-service Medicare.)
    Another change this year: enrollees in Medicare Advantage
will have an expanded “do-over” opportunity. A new Advantage
open enrollment and disenrollment will run from Jan. 1 through
March 31. During this period, you can switch between Advantage
plans or switch to traditional Medicare. (Previously, it was
possible only to disenroll from an Advantage plan.)
    
    PRESCRIPTION DRUG PLANS
    The average Medicare prescription drug plan premium is
projected to remain stable in 2019 at about $32.50 per month,
down from $33.50 in 2018, according to the Medicare Rights
Center. But premiums for specific plans can fluctuate widely
from year to year, so pay attention to whatever rate is
announced in your ANOC. 
    If you have expensive prescriptions, you will benefit from
the continued shrinking of the notorious “doughnut hole” - the
gap in plan coverage that begins when combined spending by you
and your insurer reaches a certain amount. In 2019 you enter the
gap when your own spending, including discounts by any drug
manufacturer, hits $3,820; you exit when spending reaches
$5,100.
    The gap has been closing gradually due to changes in federal
law. Next year, the gap is closed completely for brand-name
drugs, which means that enrollees will pay Part D’s standard 25
percent cost-sharing fees. The gap continues for one more year
for generic drugs; with cost-sharing of 37 percent.
    
    SHOPPING RESOURCES
    Medicare Plan Finder: Use Medicare’s official plan shopping
site (bit.ly/2IDFHEJ) to identify good-fit plans. Plug
in your Medicare number and drugs (you will need each drug’s
name and dosage). The plan finder then displays a list of plans
that match your needs, including their estimated total cost
(premiums and out-of-pocket expenses); which drugs are covered;
and customer-satisfaction ratings. The finder also will give you
advice about drug utilization and restrictions.
    Medicare & You: CMS mails out this free handbook in late
September; it contains plenty of useful information about
Medicare coverage and programs. If you have not received it,
call 1-800-Medicare to get a copy, or download it (bit.ly/2NYP1su).
 
    State Health Insurance Assistance Programs (SHIPs): Each
state has a federally funded SHIP that provides free counseling
on coverage options. Cclick here to find your local SHIP: 
(bit.ly/1OU0sfN). The Medicare Rights Center also offers free
counseling by phone (1-800-333-4114).

 (Reporting and writing by Mark Miller in Chicago
Editing by Matthew Lewis)
  
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