Medicare changes

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By Gloria Smith

Gloria Smith

A lot changed in Medicare this year with more coming in 2020.

• A new Open Enrollment was introduced to allow switching from HMO to HMO or PPO to PPO plans between Jan.1 and March 31.
• Opioid measures were introduced to help manage the recognized crisis.
• New Medicare Cards were issued.
• Announcement that Plan C and F (Medicare supplement) are no longer available to individuals eligible for the first time January 2020 and beyond.
• More PPO plans offered, some with $0 monthly premium.

• Prescription plans with deductible can increase from $415 to $435.
• Entry into the medicine coverage gap (donut hole) starts at $4,020 up from $3,820.
• Coverage gap closes at $6,350 up from $5,100.
• Member pays 25% of the cost in the gap (brand name and generics).
• More PPOs coming.
• Dental, vision, hearing and more…

NOTE: The Annual Notice of Change is sent to all current plan holders by early October each year. This notice shows the year-to-year changes (side-by-side format). Read this! Many, many plan holders place this notice in the to-be-read pile of mail received during the Annual Enrollment Period (Oct. 15-Dec. 7), but don’t take the time to study it. This is an important document and it’s a quick read.

Here is a Snapshot of the Medicare parts and how they work, and how you access them.

Medicare is available to individuals under 65 after a Social Security disability of 24 months and for individual 65 and older.

There are four parts to Medicare.

Part A: Pays for hospitalization costs (no monthly premium, if the 40 quarters of Social Security contribution is meet).

Part B: Pays for physician services, lab and X-ray services, durable medical equipment, and outpatient and other services (a monthly standard premium applies) — 2020 premium will be announced around the time Social Security changes are made public. This year’s standard premium is $135.50.

Part C: Medicare Advantage Plans (like HMO or PPO) are offered by private companies approved by Medicare (some plans required no additional monthly premium).

Part D: Assists with the cost of prescription.

1. If you are already receiving Social Security benefits, you will automatically receive your card about 3 months before your effective date. Coverage always starts on the first day of month.
2. If you are turning 65 and do not receive Social Security benefits, you can apply online with or in person at your Social Security Administration Office 3 months before your 65th birthday.

You have many choices, the most common are:
a. Original Medicare — Part A and B
b. Prescription Plan
c. Medicare Supplement
Medicare Advantage Plan (HMO/PPO) with/or without prescription coverage.

If you want complete choice of providers that accept Medicare, then search out the Medicare Supplement Plan that is best for you. Medicare Supplement plans help to pay the 20% cost that Medicare doesn’t cover. And, you will want to select a prescription drug plan. This option will include a premium for: a) Medicare Supplement; b) Prescription plan and c) Part B premium.

NOTE: there is a 1% penalty for not enrolling in a prescription plan when first eligible (if you do not have creditable coverage).

If your decision is a Medicare Advantage plan (HMO/PPO), then confirm that your doctor(s) and other providers are included in the plan. And finally, check to see if
your medicine is covered and at what cost. Check again each Annual Enrollment Period (AEP) Oct.15-Dec. 7.

This option may be at no extra premium to you. Additionally, many Medicare Advantage plans offer extra benefits, such as: over-the-counter no-cost mail order purchases of covered items (which save you money); fitness benefits at no or low costs; virtual non-emergency doctor appointments; gift card rewards for fitness assessments; and free meals after your hospital stay.

You can select your Medicare Advantage or Prescription plan up to 3 months before the effective date, the month of or up to 3 months after your effective date. Medicare Supplement Plan plans can be selected up to 6 months before your effective date.

It’s a good idea to learn all your options before making a decision.

Your mailbox will be filled with offers when you are first eligible and during the Oct. 15-Dec. 7 Annual Enrollment Period (AEP). People have told me sometimes
10-12 different offers are received daily for the 4-5 months before your effective date. Make an informed decision that fits your needs.

• You can attend a no-sales education/information session
• You can contact the Area Council on Aging in your area
• Contact Medicare directly
• You can contact Medicare brokers that offer the plan in your area.

For more information or to register for a free information session offered by Gloria, contact her at 520-568-6750, 877-542-5520 or Space is limited. Reserve your space.

Gloria Smith is an Independent Insurance Broker, main office in Maricopa, and meeting locations in Arizona City, Peoria, and Tucson. Licensed in Arizona, California, Nevada and Washington.

This column appears in the October issue of InMaricopa.