Current Medicare Advantage enrollees have seven weeks to make an important decision.
We’re talking about more than 20 million — or 34 percent — of all Medicare beneficiaries, according to the Kaiser Family Foundation. Florida has one of the highest state MA participation rates at 43 percent.
MA plans are offered by private insurance companies — predominantly United Healthcare and Humana — that are paid by Medicare to administer all Medicare services. KFF notes that half of all MA plans charge no premium. However, since they’re private companies, the plans require working within their network of local doctors, hospitals and pharmacies.
“Plans must provide all Part A and Part B services offered by Original Medicare, but can do so with different rules, costs, and restrictions that can affect how and when you receive care,” explains the Medicare Rights Center (https://www.medicareinteractive.org).
Most “all-in-one” MA plans include prescription drug coverage, as well as non-Medicare-covered benefits like dental and eye care and fitness club memberships.
But did you know that beginning this year, these supplemental benefits can include many longterm care-type services? Like in-home health aides to help with daily personal activities including dressing and eating. Or safety products like bathroom grab bars.
Prior to this year, MA enrollees were stuck with the plan chosen during the annual open enrollment period. If they weren’t happy with it, the only option was to switch back to Original Medicare before Feb. 14.
But that’s changed.
Beginning this year, there are two options: Either switch back to Original Medicare or choose a different MA plan. And the timeframe has been extended until March 31.
Understand, if you have Original Medicare, you can’t make any changes until the normal October 2019 open-enrollment period. These options are ONLY for those currently enrolled in an MA plan.
Why would you want to change plans? Perhaps a new provider isn’t in-network. Or a costly medication recently has been prescribed. Or, you’d like to take advantage of additional supplemental benefits. Or, maybe, you just didn’t deal with making any changes last year.
Regardless, you’ve got seven more weeks to decide on a do-over.
So, compare your current Advantage plan benefits and costs in 2019 to the many offered in our area using the online Medicare plan-finder tool at www.medicare.gov/find-a-plan. Compare premiums, medication co-pays, maximum annual out-of-pocket limits, and supplemental benefits. Most important, verify all your providers are “in-network.”
If you’re considering switching from your Advantage plan back to original Medicare, the plan-finder tool also allows you to compare features of all standardized, private supplemental insurance Medigap plans offered in our area. Medigap helps pay the 20 percent portion Medicare doesn’t.
However, before making this change, it’s important to know that while there’s guaranteed insurability during initial Medicare enrollment, applications for Medigap policies after that period are medically underwritten. That means they can be denied due to existing health conditions like cancer. Medigap plans also won’t pay for vision and dental care, since they’re not covered by Medicare.
Need help evaluating your choices?
The Area Agency on Aging for Southwest Florida (AAASWFL) offers one-on-one counseling services at various locations in our area with volunteer SHINE counselors. They provide free, unbiased, and personalized assistance with Medicare, Medicaid, prescription drug plans, and long-term care insurance options. SHINE is a program of the Florida Department of Elder Affairs and part of the national SHIP Program.
To speak with a SHINE counselor or make an appointment to see one, call the Elder Helpline at 866-413-5337 (866-41-ELDER). Locations and hours of counseling sites by county can be found at www.floridashine.org.
David Morris is the Sun’s consumer advocate. Contact him c/o the Sun, 23170 Harborview Road, Charlotte Harbor, FL 33980; email firstname.lastname@example.org; or leave a message at 941-206-1114.