Aimed Alliance and the National Organization for Rheumatology Managers compiled information for the Medicare Open Enrollment 2020 period.
It’s Medicare Open Enrollment 2020 time folks. There’s lots to know to make educated decisions.
What follows is some expertly curated information from the Aimed Alliance (a partner organization of Patients Rising) and the National Organization of Rheumatology Managers on how to make those educated choices about your 2020 coverage. The original PDF they created can be found here.
Choosing an appropriate Medicare plan is an important decision that can affect your health and financial stability. Once you understand the basic components of a Medicare plan and how out-of-pocket costs are calculated, you will be better equipped to select a plan that meets your needs.
Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease (ESRD). Medicare plans cover a comprehensive set of health services, but different sets of services are split among the different parts of Medicare, including Medicare parts A, B, C, and D.
Original Medicare is managed by the federal government and includes Medicare Parts A and B. To qualify for Original Medicare, you must be 65 or older, have a qualifying disability, or have End-Stage Renal Disease (ESRD).
covers inpatient care, such as treatment received in a hospital, nursing facility, and limited home health services.
covers services and supplies that are provided in an outpatient setting. It also covers prescription medications that are administered in a doctor’s office or hospital. It does not cover prescription medications that are typically taken at home.
Medicare Part D is managed by private insurers and provides prescription drug coverage. A Medicare beneficiary must have a Part A or Part B plan to qualify for Part D coverage. While most medications are covered under Medicare Part D, there are some drugs that are only covered by Medicare Part B (e.g., antigens, hemophilia clotting factors).
Medicare Advantage (MA), also referred to as “Part C,” is a Medicare health plan offered by private insurers, rather than the government. MA plans generally must offer coverage benefits equal to those provided by Original Medicare (i.e., inpatient care and outpatient services, supplies, and prescriptions). To qualify for a Medicare Advantage plan, you must be 65 or older or have a qualifying disability and live within the plan’s service area. If you have ESRD, you may not qualify for most MA plans.
With Original Medicare plans, you will receive a red, white, and blue card that you should present to your health care provider when seeking care. With MA plans, you will have a membership card that you will present to your health care provider. This card is different from the red, white, and blue card that Original Medicare enrollees receive.
With Original Medicare plans, enrollees will be able to see any provider that participates in the Medicare program. With MA plans, enrollees will only be able to see in-network providers, but a referral may needed before an enrollee can see a specialist. However, MA preferred provider organizations (PPO) plans generally allow enrollees to see an in-network specialist without a referral.
Both Original Medicare and MA plans cover the same types of services and benefits provided under Medicare Part A and Part B; however, they may have different rules, costs, and restrictions.
Original Medicare plan enrollees are charged for standardized Part A and Part B costs, including monthly Part B premiums. Enrollees must pay a 20 percent coinsurance for Medicare-covered services if they see a participating provider and after meeting their deductible.
The cost-sharing in MA plans varies based on the type of plan selected. Enrollees are typically responsible for copayments for in-network care. Plans may also charge a monthly premium in addition to the Part B premium. If your health care costs are unaffordable, you may consider enrolling in a Medigap plan, which is detailed below in the Supplemental Insurance section.
Original Medicare plans do not have annual out-of- pocket limits. MA plans do. As a result, MA enrollees cannot be required to spend more than a specific amount of money out-of-pocket each year.
Original Medicare plans require enrollment in a separate prescription drug plan through Part D. MA plans incorporate prescription drug coverage into the standard benefit package; however, many plans charge a higher premium for this coverage.
Original Medicare provides coverage of services when you travel anywhere in the United States. MA typically only provides coverage of services offered within your plan’s service areas, except in emergencies.
If you have Original Medicare, you can sign up for a Medicare supplement policy, referred to as Medigap, to help cover some of the costs that Original Medicare will not cover. This includes copayments, coinsurance, and deductibles. Enrollees will be required to pay a separate premium for the Medigap policy. Medigap policies are guaranteed to be renewable.
Medicare Advantage enrollees are ineligible for Medigap policies.
MA plans may provide additional benefits, such as routine vision or dental services, routine hearing services, and membership in fitness programs. Original Medicare plans do not offer these additional benefits.
You can sign up for an Original Medicare or MA plan as soon you first become eligible. Your initial eligibility for Medicare begins three months before your 65th birthday and lasts for seven months. For every year after that, you can sign up or make changes to your Medicare coverage during the Fall open enrollment period. If the open enrollment period has passed, you still may be able to sign up for a plan under certain circumstances referred to as special enrollment periods (SEPs).
Medicare open enrollment 2020 runs from October 15 to December 7, 2019. During this time, you can enroll in a Medicare or a MA plan. Any changes made during this period will take effect on January 1. During this period, you can make various changes to your coverage, including the following:
We recently shared information about Medicare Open Enrollment 2020 in our article, “Open Enrollment – Time to Choose your 2020 Health Plans” which you may find helpful.
We also spoke about the importance of Open Enrollment last year in Episode 6 of our Podcast.