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Medicare Open Enrollment is On Its Way

If you are a current Medicare recipient, you might know that every October you have the option to change your coverage during the Fall Open Enrollment Period (also referred to as the Annual Enrollment Period). This provides you the opportunity to review your current benefits and how they might change in the coming year, according to independent insurance agent Vince Kelly. Here’s a checklist to get you prepared for open enrollment.

Are you ready for open enrollment?

The 2020 enrollment period, as in prior years, runs from October 15 to December 7. You can make as many changes as you wish, but your final selections submitted by December 7 will stand as your new plan and will start on January 1, 2020. You don’t have to make any changes. If no changes are made, your current plan will simply continue and roll over into 2020.

From January 1 through March 31, 2020, there is also a Medicare Advantage Open Enrollment Period during which people in a Medicare Advantage Plan may make one change, which in turn will remain for the year. Kelly says this is unless you qualify for a Special Enrollment Period (SEP), in which case you may make a change during certain times of the year. One popular example of an SEP is moving out of the service area.

Have you reviewed your plan notices?

Pay attention to your mail. As early as September 15, Medicare Advantage recipients will be receiving their Annual Notification of Change (ANOC) pamphlet from their current insurance company. The ANOC shows if the plan you currently have is changing, such as moving a prescription drug to a higher tier (which could make it more expensive) or adding benefits.

It pays to compare. “Most people don’t make any changes,” Kelly says, “and some see the pamphlet and get overwhelmed.” But they shouldn’t—all you really need to do is read the chart comparing the 2019 and 2020 columns. Confirm the things you like and have had in the past year will continue next year. If you’re happy with your current doctors, your health plan benefits and your coverage, open the ANOC and check for any changes between your 2019 benefits and the upcoming 2020 benefits.

Does your existing plan meet next year's needs?

During this enrollment period you may change or join a Medicare Advantage HMO plan. The benefits of these plans are wide and they vary. Some of the most important factors are that Medicare Advantage plans typically include a Part D prescription drug plan, urgent care visits and low or no copays or deductibles.

If you are not currently in a Medicare Advantage HMO, you can join during the Medicare Annual Enrollment Period. You also have the option to just change your stand-alone Part D prescription drug plan during Medicare Annual Enrollment Period only (unless you qualify for an SEP as noted previously.)

You might need a supplement plan. Individuals who decide to pay a premium and join a stand-alone Part D plan will return to their Original Medicare and should consider applying for and purchasing a Medicare Supplement insurance (also known as Medi-Gap). A Medicare Supplement policy helps pay the 20% not covered by Original Medicare.

Is this your first time enrolling?

If you are a first-time Medicare applicant, your Initial Enrollment Period (IEP) is the seven-month period surrounding the month you turn 65—three months before the month in which you turn 65, the month of your birthday and the three months following your 65th birthday. Once you’re eligible to apply, you have the choice of Original Medicare (the fee-for-service program run by the U.S. government) or a Medicare Advantage plan (a type of private insurance offering an HMO).

Do you need Medicare supplement insurance?

Medicare Part A and Part B are considered Original Medicare and by design cover only basic services. Also there is a high hospital copayment charge with both. This is why consumers should consider adding a Medicare Supplement insurance plan to help cover costs not covered by Original Medicare.

The best time to get a Medicare Supplement plan is when you are new to Medicare because the premiums based on age and inflation will be the lowest they are ever going to be for you. Also, if you apply when you are first eligible, an insurance company can’t deny you a policy or place conditions on it. These situations include pre-existing conditions (they can’t deny you or charge you more) and moving or travel. “A supplement will also give you more control and freedom of choice,” adds Kelly.

Go to medicare.gov and/or call the THIPA Resource Center for more information: 310-257-7239; or health insurance counseling and advocacy expert Doris Herzog at 310-517-4666. Or, attend one of Torrance Health IPA's complimentary Medicare 101 lectures. Visit THIPA.org/Medicare101 to register.

Make sure you understand your options:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice and some in-home health care. For most people, Medicare Part A has a $0 monthly cost because of what they have paid into Social Security taxes.

Medicare Part B (Medical Insurance)

Part B covers certain doctor’s services, outpatient care, medical supplies and preventative services. For most services, Part B covers 80% of charges with no out-of-pocket maximum. There is a monthly cost for Part B, which is based on your income. For some, the state will subsidize, while high-income earners will pay more. Details can be found on the official Medicare website, medicare.gov.

Medicare Part C (Medicare Advantage Plans)

Medicare Advantage plans are offered by private insurance companies contracted by Medicare and include HMOs. Medicare Advantage plans cover everything that Original Medicare Parts A and B do and also offer prescription drug coverage, routine eye care, transportation and often acupuncture and other integrative treatments. Many also offer perks such as gym membership, dental discounts and allowance for over-the-counter items such as toothpaste, vitamins and skin care products. In addition, they offer several options for you to choose a medical group or an independent physician association (IPA) contracted with them, such as Torrance Health IPA (THIPA), a division of Torrance Memorial. For information about Medicare Advantage Plans, you can attend Torrance Health IPA’s Medicare 101 educational events. Visit THIPA.org/medicare101 to register.

The upside: These plans offer optimal coverage for just about anything that might arise in your life. There is great coordination of care within your IPA caregivers, and you can change your plan every year according to your needs.

One downside: You are typically limited to routine medical services within the network of your IPA or medical group.

Medicare Advantage Plans require you to choose an insurance company (such as Aetna, Anthem Blue Cross, Blue Shield of CA, Health Net, Humana, SCAN or AARP/United Healthcare) and a medical group such as nonprofit THIPA or Healthcare Partners. The insurance companies, in turn, are contracted with the IPAs so you have plenty of choices. THIPA contracts with the HMO insurance companies listed above.